New research has indicated that nearly 10 per cent of American teenagers have non-alcoholic fatty liver disease.

06/08/2012 (New Staits Times) - On the heels of human clinical studies, funded by the Malaysian Palm Oil Board (MPOB), that indicate tocotrienols found in palm fruit oil appear to reduce the severity of end-stage liver disease, new research has  indicated that nearly 10 per cent of American teenagers have non-alcoholic fatty liver disease (NAFLD).

NAFLD is the accumulation of fat in liver cells that puts teens at risk of developing later cardiovascular disease and additional liver problems.

This research carried out by the Atlanta-based Emory University School of Medicine, indicates that suspected NAFLD is increasing in teens, affecting approximately 10 per cent of the age group.

Historically seen more often in adults, NAFLD could lead to liver damage, diabetes, hypertension and cancer.

The research, reported by ABC News, suggests that the culprit may be teenage obesity.

Most of the increase in cases of NAFLD (disease not brought on by alcohol-related liver damage) is occurring among the heaviest teens -- those considered obese, based on their height, weight and age, lead researcher Dr Miriam Vos, a paediatric gastroenterologist at Emory University in Atlanta was quoted as saying.

"We tried to see where the increase was happening and it looks like it's happening in the obese group," she said.

But ill health is not inevitable for obese teens whose livers already have sustained damage, said Dr Vos, an assistant professor of paediatrics.

"We think that liver disease is reversible for teenagers if they can make substantial changes and improve their weight."

Dr Vos said the prevalence of fatty liver among American teens had more than doubled in the past two decades, from 3.6 per cent to 9.9 per cent, outpacing the rise in teenage obesity during that time and suggesting obesity was only a partial explanation for an increase.

Dr Vos' findings came from health data collected from 10,359 adolescents, aged between 12 and 18, who participated in the National Health and Examination Survey (NHANES) between 1988 and 2008.

Recent research at Ohio State University, funded by the National Institutes of Health and MPOB, had found that tocotrienols may either slow the progression of liver disease, or enable a patient to cut back on therapies, which are often not well tolerated.

A second human clinical trial on NAFLD, conducted by researchers in Malaysia, will be published soon.

The research conducted at Ohio State University's Wexner Medical Center shows that an alternative form of natural Vitamin E can delay the progression of disease in patients awaiting liver transplantation, the only definitive therapy that reduces a patient's morbidity, mortality and improves their quality of life. The study shows, for the first time, successful delivery of the vitamin -- administered orally -- to vital human organs, such as the brain, heart, liver, skin and fatty tissue.

The team of researchers led by Dr Chandan K. Sen, associate dean for translational and applied research of Ohio State University College of Medicine, also included Kalanithi Nesaretnam, from MPOB's Food Technology and Nutrition Unit.

They initially sought to measure levels of Vitamin E tocopherol (TCP) and Vitamin E tocotrienol (TE) in tissues and vital organs of patients with end-stage liver disease.

The data displayed a significant increase in TE levels in the bloodstream and tissue of participants who received daily oral supplements of TE.

"This work is the first to show that oral supplements of tocotrienol are being transported to the vital organs of patients," Dr Chandan said.

"This is an exciting evidence for patients at high risk of stroke because our previous work identified low levels of TE to be protective against stroke-induced damage to the brain.

"Findings of this current research are equally exciting for patients on the liver transplant list as it increases their chances of receiving a new liver, and therefore, survival."

Earlier research published by Dr Chandan and colleagues at Ohio State's Medical Center proved that tocotrienol was a safe and neuroprotective nutrient that minimised stroke-related damage to the brain.

"We also showed in previous studies that TE can be part of a regular diet and it enriches the brain and better prepares it to defend itself," said Dr Chandan, who is also vice-chairman for research in Ohio State University's Department of Surgery.

For this recent study, published in the February issue of the Journal of Nutrition, researchers studied blood and tissue samples from 80 participants. One cohort involved healthy patients who received oral TE, or TCP supplements.

Vitamin E levels found in tissues were measured in healthy participants after 12 weeks of receiving the oral supplementation.

Healthy adult participants were selected for this study because they could receive oral supplements for a designated period of time, whereas the other cohort was bound by its surgery schedules.

In another cohort, adult surgical patients were randomised and received daily oral supplements of either TE, or TCP.

Concentration levels of both vitamin E sources were measured in vital organs, including cardiac muscles from heart transplant patients with end-stage heart failure, liver from transplant patients with end-stage liver disease, abdominal fatty tissues from morbidly obese patients undergoing reconstructive plastic surgery and brain tissues from epileptic patients.

The results showed that oral supplementation of tocotrienol significantly increased the levels of the nutrients found in blood, skin, fatty tissues, the brain, cardiac muscles and the liver.

Tocotrienol was delivered to the human brains of study participants at levels found to be neuroprotective in earlier stroke-related research.

Oral administration of tocotrienol also lowered the model for end-stage liver disease (MELD) score in 50 per cent of the patients who received TE supplements, while only 20 per cent of patients who received TCP supplements experienced a reduction in their MELD score.

MELD score refers to a clinical scoring system used to determine the severity of chronic liver disease that assesses the priority and need for liver transplant allocation.

One of the richest and healthiest food sources for TE is palm oil, which contains an abundance of the nutrient. It contains zero trans fat content and is also a popular component of a typical Southeast Asian diet.

Other foods containing TE include rice, bran, oat, barley, and wheat germ.

Dr Chandan and colleagues are planning a much larger Phase II clinical trial testing the safety and effectiveness of tocotrienol against stroke and end- stage liver disease in humans.

Along with Dr Chandan, other Ohio State University researchers involved in the study are Viren Patel, Cameron Rink, Gayle M. Gordillo, Savita Khanna, Urmila Gnyawali, Sashwati Roy, Bassel Shneker, Kasturi Ganesh, Gary Phillips, J. Layne Moore, Atom Sarkar, Robert Kirkpatrick, Elmahdi A. Elkhammas, Emily Klatte, Michael Miller, Michael S. Firstenberg and E. Antonio Chiocca.