Epidemiology of Pediatric Nonalcoholic Fatty Liver Disease

Yu, Elizabeth L.; Schwimmer, Jeffrey B.

doi:10.1002/cld.1027

Cited by 51 publications

(43 citation statements)

References 25 publications

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“…Non-alcoholic fatty liver disease (NAFLD) is a multifaceted disease that includes a wide spectrum of liver damage, ranging from the accumulation of fat in more than 5% of hepatocytes (NAFLD) to non-alcoholic steatohepatitis (NASH), characterized by tissue necroinflammation and possible fibrosis at different stages associated with steatosis ( 1 ). NAFLD, as a feature of metabolic syndrome, is a cause of increasing concern in pediatrics, and it is estimated to affect 5–10% of children and adolescents in westernized countries ( 2 ). Several studies suggest that NASH may progress to cirrhosis and end-stage liver disease that requires liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive Diagnostic Test for Advanced Fibrosis in Adolescents With Non-Alcoholic Fatty Liver Disease

et al. 2022

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IntroductionNon-alcoholic fatty liver disease (NAFLD) is a multifaceted disease that includes a wide spectrum of liver damage. The presence and the degree of fibrosis are considered important factors for the prognosis of NAFLD and in predicting the risk of developing cirrhosis. Our aim was to evaluate the usefulness of four fibrosis scores (aspartate aminotransferase/Platelet Index [APRI], FIB-4, NAFLD Fibrosis Score [NFS], and Hepamet) in predicting different degrees of fibrosis among children with biopsy-proven NAFLD.MethodsAbout 286 adolescents [mean age 14.3 years ± 2.5; 154 (53.6%) males], referred between January 2014 and December 2019, with biopsy-proven NAFLD were enrolled.ResultsAbout 173 (60.4%) patients presented fibrosis at histological analysis. In particular: 140 (49.3%) patients had F = 1, 31 (10.8%), had F = 2 and 2 (0.66%) had F = 3. APRI (AUROC 0.619, 95% CI 0.556–0.679) and Hepamet (AUROC 0.778, 95% CI 0.722–0.828) scores had significant (p < 0.001) accuracy to distinguish subjects with fibrosis; while NFS and FIB-4 had not. APRI had a positive predictive value (PPV) of 62.77% (95% CI 57.96–67.35) and an negative predictive value (NPV) of 52.01% (95% CI 46.54–57.43); Hepamet a PPV of 63.24% (95% CI 59.95–66.41) and an NPV of 61.29% (52.9–69.01).ConclusionsOur study showed that Hepamet and APRI perform better than NFS and FIB-4 for identifying fibrosis in patients with NAFLD, but do not have PPVs so high to be considered diagnostic. Therefore, they cannot be employed, in children, for a certain diagnosis of fibrosis or its progression and cannot replace liver biopsy as the gold diagnostic standard. It is, therefore, necessary to continue to research and develop new markers of exclusive fibrosis.

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Section: Introductionmentioning

confidence: 99%

Non-Invasive Diagnostic Test for Advanced Fibrosis in Adolescents With Non-Alcoholic Fatty Liver Disease

et al. 2022

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“…After controlling for basic demographics and clinical risk factors for NAFLD in children (i.e., age, sex, ethnicity, BMI %, the presence of T2DM, and the presence OSA) (11)(12)(13)(14)(15), positive ANA in the setting of an ALT >80 had 4.6 greater odds of having an NAS ≥5 (P = 0.035, 95% CI, 1.12-19.01) (Table 3). After holding all other variables constant, ANCA positivity was associated with decreased odds of NAS ≥5 (odds ratio, 0.13; P = 0.022; 95% CI, 0.23-0.75) and lower PNHS % (P = 0.027; 95% CI, −39.69 to −2.51) (Tables 3 and 4).…”

Section: Resultsmentioning

confidence: 99%

Autoimmune Antibodies in Children and Adolescents With Nonalcoholic Fatty Liver Disease

Kohut

Shah

Russo

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives:The clinical significance of autoantibody positivity in nonalcoholic fatty liver disease (NAFLD) in the absence of autoimmune hepatitis (AIH) remains uncertain. We aimed to determine the prevalence of autoantibodies in a pediatric cohort with biopsy-proven NAFLD and investigate the association between autoantibodies and NAFLD histologic grade. Methods: Single-center, retrospective study of patients ≤21 years with biopsy-proven NAFLD from 2014 to 2019. Clinical and laboratory data were obtained within 90 days of liver biopsy. Autoantibody positivity was defined as serum titer ≥1:80 or units ≥20. Liver biopsies were evaluated for features of AIH, then scored for steatosis, hepatocyte ballooning, lobular inflammation, and NAFLD activity score (NAS) was calculated. Portal inflammation and fibrosis were scored separately. Multivariable logistic regression was used for continuous and binary outcomes. Results: Sixty-seven subjects met inclusion criteria. Positive antinuclear antibody (ANA), antismooth muscle antibody (ASMA), antineutrophil cytoplasmic antibody (ANCA), anti-F-actin antibody (F-actin), anti-liver kidney microsomal (LKM) antibody, or any combination was observed in 43%, 39%, 19%, 13%, 0%, and 66% of subjects, respectively. After controlling for confounders, positive ANA and alanine aminotransferase (ALT) >80 had 4.6 greater odds of having an NAS ≥5 (P = 0.035; 95% confidence interval [CI], 1.12-19.01). Autoantibody positivity resolution occurred in 10%-50% who underwent serial monitoring. Conclusions: Autoantibodies, except LKM, were frequently encountered in our pediatric NAFLD cohort in the absence of AIH. ANA positivity with ALT may help clinically stratify pediatric patients with suspected NAFLD targeting those at greater risk for nonalcoholic steatohepatitis (NASH).

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“…The rate is higher in some populations such as Asians and boys. [ 17 ] The results of a recent systematic review study in Iran reported an estimated rate of 27.88% among Iranian children and adolescents. [ 18 ]…”

Section: Discussionmentioning

confidence: 99%

Prevalence of nonalcoholic fatty liver disease in children with renal failure underwent treatment with dialysis

et al. 2022

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Epidemiology of Pediatric Nonalcoholic Fatty Liver Disease

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/17-3-reading-yu a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/17-3-interview-yu an interview with the author

Cited by 51 publications

References 25 publications

Non-Invasive Diagnostic Test for Advanced Fibrosis in Adolescents With Non-Alcoholic Fatty Liver Disease

Non-Invasive Diagnostic Test for Advanced Fibrosis in Adolescents With Non-Alcoholic Fatty Liver Disease

Autoimmune Antibodies in Children and Adolescents With Nonalcoholic Fatty Liver Disease

Prevalence of nonalcoholic fatty liver disease in children with renal failure underwent treatment with dialysis

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