Non‐alcoholic steatohepatitis in children and adolescents

Manton, Nicholas; Lipsett, Jill; Moore, David; Davidson, Geoffrey P.; Bourne, Anthony J.; Couper, Richard

doi:10.5694/j.1326-5377.2000.tb139299.x

Cited by 131 publications

(96 citation statements)

References 19 publications

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“…Similar high figures have been reported among children from countries in Europe and Asia 2 3 4. Insulin resistance is almost a universal finding in paediatric NAFLD and, consequently, several of the clinical features associated with insulin resistance such as obesity, diabetes mellitus and dyslipidaemia are common comorbidities in children who suffer from NAFLD 5 6 7 8 9 10 11 12 13 14…”

supporting

confidence: 59%

The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years

Feldstein

Charatcharoenwitthaya

Treeprasertsuk

et al. 2009

Gut

625

459

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Objectives: The long-term prognosis of non-alcoholic fatty liver disease (NAFLD) in children remains uncertain. We aimed at determining the long-term outcomes and survival of children with NAFLD. Design: Retrospective longitudinal hospital-based cohort study. Patients: Sixty-six children with NAFLD (mean age 13.9 (SD 3.9) years) were followed up for up to 20 years with a total of 409.6 person-years of follow-up.

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supporting

confidence: 59%

The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years

Feldstein

Charatcharoenwitthaya

Treeprasertsuk

et al. 2009

Gut

625

459

View full text Add to dashboard Cite

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“…Though many children with NAFLD are asymptomatic, some children experience right upper quadrant abdominal pain(4,22) and/or fatigue. Most children with NAFLD are obese, defined as a body mass index (BMI) ≥ 95 th percentile for age and sex.…”

Section: Diagnosismentioning

confidence: 99%

“…Most children with NAFLD are obese, defined as a body mass index (BMI) ≥ 95 th percentile for age and sex. (2,9) Upon examination, most affected children have hepatomegaly,(4,8,10,22) though this may be difficult to appreciate depending upon the degree of obesity. Insulin resistance is also common among children with NAFLD.…”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and treatment of pediatric nonalcoholic steatohepatitis and the implications for bariatric surgery

Pardee

Lavine

Schwimmer

2009

Seminars in Pediatric Surgery

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This review focuses on the diagnosis, risk factors, prevalence, pathogenesis and treatment of pediatric nonalcoholic steatohepatitis (NASH). NASH is a progressive form of nonalcoholic fatty liver disease (NAFLD), the most common cause of chronic liver disease in children. The factors that account for differences between children with NASH versus children with milder forms of NAFLD are unclear. The diagnosis of NASH requires interpretation of liver histology because no noninvasive markers predict the presence or severity of NASH. There is no proven treatment for NASH. Several clinical trials for NAFLD are in progress, however, clinical trials focusing on NASH are needed. Heightened physician awareness of NAFLD, NASH, and associated risk factors is important to identify and treat affected children. Keywordscirrhosis; histology; obesity; nonalcoholic fatty liver disease; pediatric; children Nonalcoholic steatohepatitis (NASH) was first documented in children in 1983(1), and has since been recognized as a progressive form of nonalcoholic fatty liver disease (NAFLD). Liver histology in NAFLD ranges from simple steatosis, to steatosis with inflammation and cellular injury (NASH). Fibrosis, including cirrhosis, may also be present in NAFLD. NASH is included within the spectrum of NAFLD. In this review, the term 'NAFLD' is used to refer to the entire spectrum of histology, while 'NASH' refers only to the subset of NAFLD with histology consistent with NASH.NAFLD is the most common cause of chronic liver disease in American children,(2) and has been described throughout much of the world.(3-8) Children with NAFLD can have advanced fibrosis or cirrhosis.(9-11) NAFLD in children is strongly associated with metabolic syndrome, greatly increasing the potential for future cardiovascular disease and diabetes mellitus.(12) Thus the potential for adverse outcomes coupled with the high prevalence of the disease makes for a considerable public health concern. Recent studies indicate that NAFLD is under-© 2009 Elsevier Inc. All rights reserved.Correspondence: Jeffrey B. Schwimmer, M.D., Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, 200 West Arbor Drive, San Diego, CA 92103-8450, e-mail: jschwimmer@ucsd.edu, phone: 619-543-7544, fax: 619-543-7537. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (13,14) indicating a need to heighten physician awareness of this disease. NIH Public AccessIn the past 4 years, many reviews have described NAFLD in children;(15-21) however, these have not focused on NASH. Children with...

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“…Ten to 77% of children with obesity have evidence of hepatic fatty infiltration by ultrasound and 25% of them have elevation of liver enzymes [5, 6]. Children with NAFL are usually asymptomatic, they may present with vague abdominal pain and incidental elevation of alanine aminotransferase (ALT) screened due to child’s body habitus [7, 8]. NAFL is uncommon in children under 8 years of age, the average age at presentation is 12 years [9].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors for non-alcoholic fatty liver in children and youth with obesity

et al. 2017

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BackgroundNon- Alcoholic Fatty Liver (NAFL) is a spectrum of liver diseases (LD) that ranges from benign fatty infiltration of the liver to cirrhosis and hepatic failure. Hepatic ultrasound (US) and serum alanine aminotransferase (ALT) are often used as markers of NAFL. Our aim is to describe prevalence of NAFL and associated findings on ultrasound (US) and biochemical parameters in a population of children and adolescents with obesity at the Children’s Hospital of Eastern Ontario.MethodsChildren with Obesity (BMI >95th percentile) ages 8–17 years presenting to the Endocrinology and Gastroenterology clinics, without underlying LD were prospectively recruited from 2009 to 2012. Fasting lipid profile, HOMA IR) and serum adiponectin levels were measured. NAFL was defined as ALT > 25 and >22 IU/mL (males and females respectively) and/or evidence of fatty infiltration by US. Logistic regression was performed to assess associations.Results97 children with obesity included in the study (Male 43%). Mean age was 12.9 ± 3.2 years (84% were older than 10 y). Mean BMI-Z score was 3.8 ± 1.4. NAFL was identified in 85%(82/97) of participants. ALT was elevated in 61% of patients. Median triglyceride (TG) level was higher in children with NAFL(1.5 ± 0.9 vs. 1.1 ± 0.5 mmol/L, p = 0.01). Total cholesterol, HDL, LDL and Non HDL cholesterol were similar in both groups(p = 0.63, p = 0.98, p = 0.72 and p = 0.37 respectively). HOMA IR was ≥3.16 in 53% of children(55% in those with NAFL and 40% in those without NAFL). Median serum adiponectin was 11.2 μg/ml(IQR 7.3–18.3) in children with NAFL vs. 16.1 μg/ml(IQR 9.0–21.9) in those without NAFL(p = 0.23). Liver US was reported as normal in 30%, mild fatty infiltration in 38%, moderate in 20% and severe in 12%. TG were significantly higher(1.5 mmol/L vs. 1.0 mmol/L, p < 0.01) and HDL-C was lower(1.0 mmol/L vs. 1.1 mmol/L, p = 0.05) in children with moderate and severe NAFL by US. BMI-Z score, HOMA IR, serum adiponectin and HDL levels were not associated with NAFL, however TG were significantly associated(OR = 3.22 (95% CI: 1.01–10.25, p = 0.04)).ConclusionNAFL is highly prevalent in obese children and youth. Elevated TG levels are associated with NAFL; these findings may serve as a noninvasive screening tool to help clinicians identify children with obesity needing liver biopsy and/or more aggressive therapeutic interventions.

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Non‐alcoholic steatohepatitis in children and adolescents

Cited by 131 publications

References 19 publications

The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years

The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years

Diagnosis and treatment of pediatric nonalcoholic steatohepatitis and the implications for bariatric surgery

Prevalence and risk factors for non-alcoholic fatty liver in children and youth with obesity

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