Objective
Animal models and studies in adults have demonstrated that copper restriction increases severity of liver injury in non-alcoholic fatty liver disease (NAFLD). This has not been studied in children. We aimed to determine if lower tissue copper is associated with increased NAFLD severity in children.
Methods
This was a retrospective study of pediatric patients who had a liver biopsy including a hepatic copper quantitation. The primary outcome compared hepatic copper concentration in NAFLD versus non-NAFLD. Secondary outcomes compared hepatic copper levels against steatosis, fibrosis, lobular inflammation, balloon degeneration, and NAFLD activity score (NAS).
Results
The study analysis included 150 pediatric subjects (102 with NAFLD and 48 non-NAFLD). After adjusting for age, BMI z-score, GGT, ALT, and total bilirubin, NAFLD subjects had lower levels of hepatic copper than non-NAFLD (p=0.005). Additionally, tissue copper concentration decreased as steatosis severity increased (p<0.001). Copper levels were not associated with degree of fibrosis, lobular inflammation, portal inflammation, or balloon degeneration.
Conclusions
In this cohort of pediatric subjects with NAFLD, we observed decreased tissue copper levels in subjects with NAFLD when compared to non-NAFLD subjects. Additionally, tissue copper levels were lower in subjects with non-alcoholic steatohepatitis, a more severe form of the disease, when compared to steatosis alone. Further studies are needed to explore the relationship between copper levels and NAFLD progression.