***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of this study was to investigate the effects of vitamin D supplementation on serum aminotransferases , insulin resistance , oxidative stress , and inflammatory biomarkers in adult patients with non-alcoholic fatty liver disease ( NAFLD ) . Fifty-three patients with NAFLD were enrolled in a parallel , double-blind , placebo-controlled study . The patients were r and omly allocated to receive either one oral pearl consisting of 50,000 IU vitamin D3 ( n = 27 ) or a placebo ( n = 26 ) , every 14 days for 4 months . Serum aminotransferases , high-sensitive C-reactive protein ( hs-CRP ) , tumor necrosis factor α , malondialdehyde ( MDA ) , total antioxidant capacity , transforming growth factor β1 , as well as grade of hepatic steatosis and homeostasis model assessment of insulin resistance were assessed pre- and post-intervention . In patients who received vitamin D supplement compared to the controls , the median of serum 25(OH)D3 significantly increased ( 16.2 vs. 1.6 ng/ml , P < 0.001 ) . This increase accompanied by significant decrease in serum MDA ( −2.09 vs. −1.23 ng/ml , P = 0.03 ) and near significant changes in serum hs-CRP ( −0.25 vs. 0.22 mg/l , P = 0.06 ) . These between-group differences remained significant even after controlling for baseline covariates . Other variables showed no significant changes . Improved vitamin D status led to amelioration in serum hs-CRP and MDA in patients with NAFLD . This might be considered as an adjunctive therapy to attenuate systemic inflammation and lipid peroxidation alongside other treatments for NAFLD patients Background Non-alcoholic fatty liver disease ( NAFLD ) is the most common hepatic disorder worldwide , reaching prevalence up to 90 % in obese patients with type 2 diabetes ( T2D ) , and representing an independent risk factor for cardiovascular mortality . Furthermore , the coexistence of T2D and NAFLD leads to higher incidence of diabetes ’ complications and additive detrimental liver outcomes . The existence of a close association between NAFLD and hypovitaminosis D , along with the anti-inflammatory and insulin-sensitizing properties of vitamin D , have been largely described , but vitamin D effects on hepatic fat content have never been tested in a r and omized controlled trial . We assessed the efficacy and safety of 24-week oral high-dose vitamin D supplementation in T2D patients with NAFLD . Methods This r and omized , double-blind , placebo-controlled trial was carried out at the Diabetes Centre of Sapienza University , Rome , Italy , to assess oral treatment with cholecalciferol ( 2000 IU/day ) or placebo in T2D patients with NAFLD . The primary endpoint was reduction of hepatic fat fraction ( HFF ) measured by magnetic resonance ; as hepatic outcomes , we also investigated changes in serum transaminases , CK18-M30 , N-terminal Procollagen III Propeptide ( P3NP ) levels , and Fatty Liver Index ( FLI ) . Secondary endpoints were improvement in metabolic ( fasting glycaemia , HbA1c , lipids , HOMA-IR , HOMA-β , ADIPO-IR , body fat distribution ) and cardiovascular ( ankle-brachial index , intima-media thickness , flow-mediated dilatation ) parameters from baseline to end of treatment . Results Sixty-five patients were r and omized , 26 ( cholecalciferol ) and 29 ( placebo ) subjects completed the study . 25(OH ) vitamin D significantly increased in the active treated group ( 48.15 ± 23.7 to 89.80 ± 23.6 nmol/L , P < 0.001 ) ; however , no group differences were found in HFF , transaminases , CK18-M30 , P3NP levels or FLI after 24 weeks . Vitamin D neither changed the metabolic profile nor the cardiovascular parameters . Conclusions Oral high-dose vitamin D supplementation over 24 weeks did not improve hepatic steatosis or metabolic/cardiovascular parameters in T2D patients with NAFLD . Studies with a longer intervention period are warranted for exploring the effect of long time exposure to vitamin D.Trial registration This trial was approved on July 2011 by the Ethics Committee of Policlinico Umberto I , Sapienza University of Rome , Italy , and registered at www . clinical trialsregister.eu number 2011 - 003010 - 17 Background There are no licensed treatments for non alcoholic fatty liver disease ( NAFLD ) in adults or children . In NAFLD , several studies have shown a benefit of omega-3 fatty acid treatment on lipid profile , insulin-sensitivity and hepatic steatosis and it has also been suggested that Vitamin D treatment has potential antifibrotic properties in liver disease . Trial Design To date , however , there are no studies that have tested the combination of Docosahexanoic acid ( DHA ) and vitamin D treatment which may benefit the whole spectrum of disease in NAFLD . Our aim therefore , was to test the effect of daily DHA ( 500 mg ) plus vitamin D ( 800 IU ) treatment , in obese children with biopsy-proven NAFLD and vitamin D deficiency , in a r and omized , double-blind placebo-controlled trial . Methods The 41/43 patients completed the study ( 18-treatment , 23-placebo ) . At 12 months : i ) the main outcome was liver histology improvement , defined by NAS ; ii ) the secondary outcome was amelioration of metabolic parameters .  Results DHA plus vitamin D treatment reduced the NAFLD Activity Score ( NAS ) , in the treatment group ( 5.4 v1.92 ; p<0.001 for baseline versus end of study ) . There was no change in fibrosis score , but a reduction of the activation of hepatic stellate cells ( HSC ) and fibrillar collagen content was noted ( 3.51±1.66 v. 1.59±1.37 ; p = 0.003 ) in treatment group . Moreover , the triglycerides ( 174.5 vs. 102.15 mg/dl ) , ALT ( 40.25 vs. 24.5 UI/l ) and HOMA-IR ( 4.59 vs. 3.42 ) were all decreased with treatment . Conclusion DHA plus vitamin D treatment improved insulin-resistance , lipid profile , ALT and NAS . There was also decreased HSC activation and collagen content with treatment OBJECTIVE Evidence indicates that NAFLD patients are vitamin D deficient . Vitamin D has new roles in lipid and glucose metabolism . The aim of this study was to examine the effects of calcitriol supplementation on the NAFLD progression based on liver lipid accumulation , serum lipid profile and insulin resistance . METHODS We r and omly assigned 73 patients with NAFLD-confirmed by ultra-sonography to 12 weeks of treatment with hypocaloric diet ( reduction of 500 kcal per day ) plus 25 µg of calcitriol supplement or a hypocaloric diet plus placebo . Before and after treatment , we assessed anthropometric parameters , grade of fatty liver , serum lipoproteins , liver enzymes and insulin level . RESULT Baseline variables were not significantly different between groups . A statistically significant reduction in anthropometric measures was observed over the 12 weeks in both groups . However , no significant differences were seen between groups after intervention . Compared with the placebo , reductions in triglyceride and an increase in HDL cholesterol were seen over the 12 weeks of intervention in the calcitriol group ( P = 0.002 and P = 0.004 ) . AST level was decreased in the calcitriol group ( -4.2 ± 4.3 µmol/L , P < 0.001 ) , but increased in the placebo group ( 12.6 ± 6.1 µmol/L , P = 0.02 ) after 12 weeks . Reductions in mean difference of ALT , insulin and HOMA were significantly higher in the calcitriol than placebo group ( P = 0.01 , P = 0.007 and 0.01 ) . CONCLUSIONS Calcitriol supplementation combined with weight loss diet showed no significant effects on anthropometric measures in NAFLD patients . However , it may have positive effects on lipid profile , liver enzyme tests and insulin sensitivity during a weight-loss program Background : Hypovitaminosis D is associated with an increased severity of nonalcoholic fatty liver disease ( NAFLD ) , but reports on the response to cholecalciferol ( vitamin D3 ) supplementation are conflicting . Objective : The objective of this study was to determine if st and ard vitamin D3 supplementation is effective in NAFLD with hypovitaminosis D. Methods : Sixty-five well-characterized adults [ age ( mean ± SD ) : 51.6 ± 12.3 y ] with biopsy-proven NAFLD were screened . Forty-two patients ( the ratio of men to women was 13:29 ) had hypovitaminosis D ( plasma 25-hydroxyvitamin D [ 25(OH)D ] < 30 ng/mL ) . An observational study was performed in NAFLD patients with hypovitaminosis D treated with 2000 IU cholecalciferol ( vitamin D3 ) daily for 6 mo per clinical practice . Plasma 25(OH)D , hepatic and metabolic panels , and metabolic syndrome components were assessed before and after cholecalciferol supplementation . Body composition was measured by using bioelectrical impedance analysis . The primary outcome measure was plasma 25(OH)D ≥30 ng/mL at the end of the study . Secondary outcomes included change in serum transaminases , fasting plasma glucose , and insulin and homeostasis model assessment of insulin resistance ( HOMA-IR ) . Chi-square , Student 's t tests , correlation coefficient , and multivariate analysis were performed . Results : Twenty-six ( 61.9 % ) patients had nonalcoholic steatohepatitis ( NASH ) , and 16 ( 38.1 % ) had hepatic steatosis . After 6 mo of cholecalciferol supplementation  , plasma 25(OH)D ≥30 ng/mL was observed in 16 subjects ( 38.1 % ; responders ) whereas the remaining 26 patients ( 61.9 % ) were nonresponders with plasma 25(OH)D < 30 ng/mL. Significantly fewer ( P < 0.01 ) patients with NASH were responders ( 4 of 26 , 15.4 % ) than those with hepatic steatosis ( 12 of 16 , 75 % ) . Baseline fasting serum alanine aminotransferase , plasma glucose , and HOMA-IR were similar in the responders and nonresponders , but the NASH score on the liver biopsy was lower ( 16.5 % ) in the responders ( P < 0.001 ) . Nonresponders had a higher fat mass ( 10.5 % ) and lower fat-free mass ( 10.4 % ) than responders did . End-of-treatment alanine aminotransferase and HOMA-IR improved only in responders . The baseline HOMA-IR and histological NASH score were independent predictors of nonresponse to cholecalciferol supplementation . Conclusions : Daily supplementation with 2000 IU cholecalciferol for 6 mo did not correct hypovitaminosis D in the majority of patients with NASH . Further studies are needed to determine if higher doses are effective . This trial was registered at clinical trials.gov as 13 - 00153 BACKGROUND & AIMS Hypovitaminosis D is common in obesity and insulin-resistant states . Increased fat mass in patients with non-alcoholic fatty liver disease ( NAFLD ) may contribute to hypovitaminosis D. To determine the relation among plasma vitamin D concentration , severity of disease and body composition in NAFLD . METHODS  Plasma vitamin D concentration  was quantified in 148 consecutive biopsy-proven patients with NAFLD ( non-alcoholic steatohepatitis - NASH : n = 81 ; and hepatic steatosis : n = 67 ) and healthy controls ( n = 39 ) . NAFLD was scored using the NASH CRN criteria . Body composition was quantified by bioelectrical impedance analysis and abdominal CT image analysis . RESULTS Plasma vitamin D concentration was significantly lower in NAFLD ( 21.2 ± 10.4 ng/ml ) compared with healthy controls ( 35.7 ± 6.0 ng/ml ) . Higher NAFLD activity scores were associated with lower plasma concentration of vitamin D ( r(2 ) = 0.29 ; P < 0.001 ) . Subgroup analysis among patients with NAFLD showed that patients with NASH had significantly lower ( P < 0.01 ) vitamin D levels than those with steatosis alone ( 18.1 ± 8.4 vs. 25.0 ± 11.3 ng/ml ) . Low concentrations of vitamin D were associated with greater severity of steatosis , hepatocyte ballooning and fibrosis ( P < 0.05 
    Output:
    
Low vitamin D status is not associated with higher stages of liver fibrosis in patients with NAFLD