La steatosi epatica non alcolica è la più comune causa di malattia epatica cronica in bambini e adolescenti in Gran Bretagna, e probabilmente anche nel nostro Paese. L’alimentazione è certamente coinvolta nell’insorgenza di questa patologia epatica, e questo studio inglese ha voluto approfondire se, in bambini e ragazzini di 3, 7 e 13 anni, sia l’apporto calorico totale, o piuttosto l’assunzione dei diversi macronutrienti, a condizionarne la successiva comparsa. Ne è emerso che è il consumo calorico totale elevato in età pediatrica e pre-adolescenziale, e non i diversi macronutrienti consumati (grassi, proteine, carboidrati), a incrementare il rischio di steatosi non alcolica a 18 anni. Le associazioni positive rilevate per l’apporto di alcuni macronutrienti, infatti, scompaiono dopo l’aggiustamento statistico per la massa grassa totale, confermando il ruolo centrale di questo parametro. L’eccesso calorico in età pediatrica, di qualunque natura, si conferma quindi, secondo questo studio, come il principale determinante della comparsa di steatosi epatica nella successiva fase adolescenziale.
Glossario
Carboidrati
Rappresentano la principale fonte energetica della dieta. Sono di due tipi: semplici e complessi. I semplici sono gli zuccheri, i complessi includono amido e fibra. Forniscono 4 calorie per grammo. Si trovano naturalmente in pane, cereali, frutta, verdura, latte e latticini. Torte, biscotti, gelati, caramelle, succhi di frutta e altri alimenti di questo tipo sono ricchi di zuccheri.
Childhood Energy Intake, Not Macronutrient Intake, Is Associated with Nonalcoholic Fatty Liver Disease in Adolescents.
Anderson EL, Howe LD, Fraser A, Macdonald-Wallis C, Callaway MP, Sattar N, Day C, Tilling K, Lawlor DA
J Nutr. 2015 Mar 18. pii: jn208397. [Epub ahead of print]BACKGROUND: Greater adiposity is an important risk factor for nonalcoholic fatty liver disease (NAFLD). Thus, it is likely that dietary intake is involved in the development of the disease. Prospective studies assessing the relation between childhood dietary intake and risk of NAFLD are lacking.
OBJECTIVE: This study was designed to explore associations between energy, carbohydrate, sugar, starch, protein, monounsaturated fat, polyunsaturated fat, saturated fat, and total fat intake by youth at ages 3, 7, and 13 y and subsequent (mean age: 17.8 y) ultrasound scan (USS)-measured liver fat and stiffness and serum alanine aminotransferase, aspartate aminotransferase, and γ-glutamyltransferase. We assessed whether observed associations were mediated through fat mass at the time of outcome assessment.
METHODS: Participants were from the Avon Longitudinal Study of Parents and Children. Trajectories of energy and macronutrient intake from ages 3-13 y were obtained with linear-spline multilevel models. Linear and logistic regression models examined whether energy intake and absolute and energy-adjusted macronutrient intake at ages 3, 7, and 13 y were associated with liver outcomes.
RESULTS: Energy intake at all ages was positively associated with liver outcomes; for example, the odds of having a USS-measured liver fat per 100 kcal increase in energy intake at age 3 y were 1.79 (95% CI: 1.14, 2.79). Associations between absolute macronutrient intake and liver outcomes were inconsistent and attenuated to the null after adjustment for total energy intake. The majority of associations attenuated to the null after adjustment for fat mass at the time liver outcomes were assessed.
CONCLUSION: Higher childhood and early adolescent energy intake is associated with greater NAFLD risk, and the macronutrients from which energy intake is derived are less important. These associations appear to be mediated, at least in part, by fat mass at the time of outcome assessment.