Background: Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent chronic liver disease which occurs in the setting of insulin resistance and increased adiposity. It has rapidly evolved into the most common liver disease seen in the pediatric population. NAFLD can be divided into non-alcoholic fatty liver (NAFL), which denotes bland steatosis, and non-alcoholic steatohepatitis (NASH), which is marked by steatosis and lobular inflammation and hepatocellular injury. Additionally, the presence of fibrosis may indicate a more severe phenotype even in the absence of NASH. Liver biopsy should be considered for the assessment of NAFLD in children who have increased risk of NAFLD and increased liver enzymes or splenomegaly. We aimed to investigate NAFLD in youth with overweight/obesity.
Methods: We performed retrospective analyses of the clinical, laboratory, imaging and histological data of 37 children and adolescents with overweight/obesity, followed at our Institution, who underwent liver biopsy between 2006 and 2017. Participants underwent liver biopsy during bariatric surgery (n=22) or percutaneously (n=15). The presence of co-morbidities such as increased liver enzymes (ALT≥80; AST/ALT>1); splenomegaly, hypertension (BP≥130x80mmHg/use of anti-hypertensive medications), Type 2 diabetes (T2D; 2h-OGTT≥200mg/dL), impaired glucose tolerance (IGT; 140<2hOGTT<200mg/dL), insulin resistance (HOMA-IR ≥2.5), and dyslipidemia (TC≥200 or non-LDL-C>135 or HDL-C<40 for boys and <45 for girls or TG>130 mg/dL) were computed. Participants with other causes of chronic liver diseases were excluded. Results were based on the NASPGHAN criteria.
Results: The mean age of the participants was 15.8 years (±3.29) and 65% were boys. Mean BMI was 39.3kg/m2 and all participants had a waist circumference ≥90th percentile. While 73% had liver steatosis diagnosed by the ultrasound, none had splenomegaly. Although only 4 participants had increased liver enzymes, NAFLD was diagnosed in 33 (89%) patients. The histological evaluation showed liver steatosis in 89% of the samples (30.3% stage 1; 39.4% stage 2; 30.3% stage 3). From those 33 participants, 63.3% also presented with steatohepatitis (76.2% stage 1; 9.5% stage 2; 14.3% stage 3) and 63.6% with fibrosis. Moreover, NASH was diagnosed in 24 (72.7%) of those participants. T2D, IGT, insulin resistance, hypertension and dyslipidemia were present in 8.1%, 5.4%, 91.9%, 59.5%, 73% participants, respectively.
Conclusion: NAFLD was highly prevalent among youth with overweight/obesity. Since NAFLD can result in progressive fibrosis and lead to end-stage liver disease, we should consider other screening tests, aside from increased liver enzymes and splenomegaly, in order to make early diagnosis in this population.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology