|Jin et al. , 2014, USA||24 overweight adolescents (11–18 years) with hepatic fat >8% on MRS||Calorie-matched study-provided fructose only or glucose only beverages (3 × 8 fl bottles per day), for 4 weeks||(1) Hepatic steatosis (measured by MRS), ALT, AST|
(2) Associated cardiovascular risk factors (BW, TG, FI, HOMA-IR, FFA, LDL)
|No significant change in hepatic fat, liver enzymes or body weight in either group. In the glucose beverage group there was significantly improved HOMA-IR, hs-CRP, and LDL oxidation.|
|Schwarz et al. , 2017, USA||Obese Children (9–18 years old; n = 41) with habitual high sugar consumption||9 days of isocaloric fructose restriction||(1) Liver, visceral and subcutaneous fat|
(2) de novo lipogenesis (DNL)
|Reductions in liver fat, visceral fat and DNL after fructose restriction|
|Jin et al. , 2012, USA||Nine children with NAFLD and 10 matched controls without NAFLD (11–18 years old)||24-h periods of isocaloric macronutrient-balanced meals with either a fructose beverage or a glucose beverage||Plasma glucose, insulin, triglyceride, apolipoprotein B, high-density lipoprotein cholesterol, and nonesterified free fatty acid levels.||Effects of fructose on plasma lipids occurred in both healthy and NAFLD children, being the latter more sensitive to fructose actions|
|Jin et al. , 2014, USA||As in Jin et al. [88,96]||As in Jin et al. [88,96]||As in Jin et al. [88,96]||Endotoxin levels in NAFLD increased after fructose beverages compared to healthy children.|
|Omega 3 Fatty Acids|
|Nobili et al. [107,108], 2011, 2013, Italy||60, <18 years||DHA 500 mg/day, or DHA 250 mg/day, or placebo for 24 months (with evaluations at 6, 12, 18, and 24 months)||(1) Change in liver fat (detected by ultrasonography)|
(2) TG, ALT, BMI, HOMA-IR
|The severity of liver steatosis decreased in both treated groups vs. placebo (OR ≤ 0.02, p ≤ 0.05). TG were lower in both the treated groups. ALT was lower in the treatment groups from month 12 onwards. HOMA was lower in the DHA 250 mg group vs. placebo at 6 and 12 months.|
|Boyraz et al. , 2015, Turkey||108 obese adolescents, 9–17 years||1000 mg/day omega-3 plus diet (50% carbohydrates, 20% protein and 30% fat) plus lifestyle intervention (exercise three times per week for 1 h and the promotion of self-initiated physical activities) or placebo plus diet plus lifestyle intervention for 12 months||(1) US, ALT, AST |
(2) BMI, HDL-C, TG, TC, FI, FG, IS, HOMA-IR, SBP
|Improvement of steatosis, ALT and AST in both groups.|
Increase HDL-C, improvement of TG, FI and HOMA-IR.
Improvement in BMI in the intervention and control groups. Improvement of SBP in the intervention group.
|Janczyk et al. , 2015, Poland||76||450–1300 mg/day 3:2 DHA:EPA plus individually prescribed diet and PA versus omega 6 sunflower oil for 6 months||(1) ALT, AST, GGT |
(2) FSG, FI, HOMA- IR, adiponectin, cholesterol, steatosis (US), BMI, WC
|Lower ALT levels in both groups the intervention and control (but without statistical difference between the groups).|
Lower AST and GGT levels in the intervention group.
No changes in ALT, steatosis, FSG, FI, HOMA-IR, BMI z score or WC z score in both groups.
|Pacifico et al. , 2015, Italy||51, <18 years||250 mg/day DHA plus low-calorie diet plus 60 min PA 5 times a week versus placebo (290 mg/day linoleic acid) for 6 months||(1) Hepatic fat, ALT|
(2) TG, Z-BMI, FI, HOMA-IR
|Lower hepatic fat by MRS, FI, and TG in the intervention group.|
|Vajro et al. , 2004, Italy||28 obese participants, age range NR||Oral a-acetatetocopherol (400 mg/day for 2 months, 100 mg/day for 3 months) plus low-calorie diet plus exercise versus placebo||(1) Liver echogenicity, ALT|
|Results were stratified based on weight loss: decrease BMI plus vitamin E: improved liver echogenicity, and ALT levels. Stable BMI plus vitamin E: improved the liver echogenicity.|
|Nobili et al. [35,130], 2006, 2008, Italy||90 participants, 3–18 years||Alpha-tocopherol (600 ID/d) plus ascorbic acid (500 mg/day) plus hypo-/isocaloric diet plus 45 min/day aerobic exercise versus placebo for 24 months||(1) NAFLD Activity Score, ALT, AST|
(2) Z-BMI, BMI, TG, TC, FSG, FI, HOMA-IR
|Improvement in NAFLD activity score, ALT, and AST in both the intervention and control groups (but without statistical difference between the groups).|
|Wang et al. , 2008, China||76 obese children with NAFLD, 10–17 years||Three groups: Vitamin E (100 mg/day) versus life-style interventions (low calorie diet + exercise + reduced caloric intake) versus no intervention||(1) US, ALT, AST|
(2) Z-BMI, TG, TC, FSG, FI, HOMA
|No change to liver echogenicity in any group. Reduction in ALT, AST, BMI, TG, TC, FI, FSG and HOMA- IR in the intervention group.|
|Lavine et al. , 2011, USA||173 participants, 8–17 years||
800 IU of vitamin E (58 patients), 1000 mg of metformin (57 patients), or placebo (58 patients) for 96 weeks
(2) NAFLD activity score, QOL, Z-BMI, BMI, BW, WC, TG, TC, FSG, HOMA-IR, HDL, LDL
|No significant improvement in ALT levels between the groups.|
Improved the NAFLD activity score in the intervention group.
Resolution of NASH was significantly greater in the children treated with vitamin E versus the placebo group.
|Murer et al. , 2014, Switzerland||
44 overweight or obese children and adolescents, 10–18 years
Daily antioxidants (vitamin E, 400 IU; vitamin C, 500 mg; selenium, 50 μg) plus lifestyle modifications or placebo for 4 months
||(1) Biomarkers of oxidative stress, inflammation, and liver function||Significant treatment effect of antioxidant supplementation on antioxidant status and on ALT.|