Arachidonic acid to docosahexaenoic acid ratio (AA/DHA): a strong clinical outcome predictor in DHA-based nutritional therapy of pediatric NASH

In two consecutive randomized placebo-control trials, DHA has been used in combination with other micronutrient vitamins (choline (CHO), vitamin E as alpha-tocopherol and vitamin D) to treat obese nonalcoholic steatohepatitis (NASH) patients along with dietary restriction and physical activity. Regardless of micronutrient vitamins combination, the two DHA-based trials resulted in an improved liver echogenicity (primary end-point), NAFLD Activity Score (NAS) that included biopsy-derived fibrosis and steatosis indices, and metabolic parameters such as fasting blood glucose, LDL, triglycerides and AST. In these trials increased concentrations of plasma free DHA and, even more, a decreased AA/DHA ratio were the strongest predictors of the clinical outcome. A stable correction of DHA concentrations and metabolism may thus represent a major nutritional end-point and precious indicator in the clinical management of pediatric NASH. DHA therapy deserves further investigation as a first-lane intervention in these patients.