RESUMO
Although non-alcoholic fatty liver [NAFL] histologically presents only steatosis, non alcoholic steatoheptitis [NASH] present fibrosis and inflammatory infiltration as well as stealosis. NASH sometimes progresses to liver cirrhosis, but it is not easy to distingvish this disease from NAFL by non-invasive examinations. Transforming growth factor- beta1 [TGF-beta1] is implicated in the development of liver fibrosis. Effective treatment for this disease has not been established. This study was designed to determine the diagnostic significance of measurement of plasma TGF-beta1 level in obese children and adolescents with fatty liver disease as well as to evaluate the efficacy of vitamin E treatment on the clinical course of the disease. Thirty-six obese children and adolescents [age 7-18 yrs] with elevated serum aminotransferase [ALT and AST] levels for more than 3 months with diffusely echogenic liver on ultrasonography and, without demonstrable cause for the abnormal chemistry, were diagnosed to have NAFL disease. They were histologically, 22 NAFL and 16 NASH. Clinical details, investigations including LFTs, serum lipid and alpha-tocopherol/ lipid arid plasma TGF-beta1 levels as well as histology were evaluated at admission and after treatment with oral vitamin E 300-900 IU daily. Serum ALT and AST levels were monitored monthly during treatment twenty age and sex matched healthy children served as controls. Results Duration of follow up was 3-8 months. Plasma TGF-beta1 levels were significantly elevated in NASH compared to NAFL patients and controls and decreased accompanied by an improvement in LFTs and histology following vitamin E treatment. Serum alpha-tocopherol/lipid levels were significantly decreased in patients than controls and significantly elevated following treatment. Measurement of plasma TGF-beta1 level represents a possible method of distinguishing between NAFL and NASH, and is also a good indicator of the efficacy of treatment for NASH. Vitamin E may have a beneficial therapeutic effect in children and adolescents with NASH