The changing face of hepatitis in boys with haemophilia associated with increased prevalence of obesity

Abstract

Hepatitis in children with haemophilia was historically most often associated with transfusion-transmitted infections. However, with the use of recombinant clotting factor concentrates, acquisition of such infections has now become rare. We studied the profile of hepatitis in North-American children with haemophilia in the modern era of safe blood products and excess childhood obesity. A total of 173 boys (<18 years) registered in the Pediatric Comprehensive Care Haemophilia Program were included in this retrospective study. Hospital records were reviewed for baseline data, serial height and weight measurements and serial alanine aminotransferase (ALT) levels. A body mass index (BMI) ranking was available for 170 boys, of whom 25 (14.7%, 95% CI 9.7-20.9%) were obese. The rate of obesity was higher in severe haemophilic boys. Compared with the general childhood population, the rate of obesity trended towards being higher in young haemophilic boys (2-5 years), but was similar in other age groups. A persistently high ALT (≥80 U L(-1) ) was documented in 5 boys and was associated with obesity. Three boys had clinical and imaging studies compatible with non-alcoholic fatty liver disease (NAFLD). Overweight and obesity are common among haemophilic boys, especially those who are younger and with severe disease. In this large group of haemophilic boys, chronic viral hepatitis was rare and NAFLD was a more common cause of liver disease. Overweight and obese haemophilic boys should be evaluated for NAFLD and interventional programmes should be designed to reduce the potential complications associated with obesity.

The role of disease severity in influencing body mass index in people with haemophilia: a single‐institutional cross‐sectional study

“…Three prevalence studies have arrived at discrepant findings on the relationship between haemophilia severity and BMI [6, 8, 19]. Revel-Vilk et al in a large cohort found that younger boys with severe haemophilia were more likely to be obese [19].…”

“…To date, only prevalence studies have examined the relationship between haemophilia disease severity and obesity with discrepant findings [6, 8, 19]. These studies have either had few participants or have been exclusively of pediatric populations.…”

An inventory of healthy weight practices in federally funded haemophilia treatment centres in the United States

“…Persons with hemophilia are living longer and therefore are at risk for developing chronic conditions that may be further complicated by overweight/obesity [5, 6, 7, 8]. Emerging evidence makes the importance of obesity prevention clear.…”

“…Interestingly, in a 2011 Canadian study of boys under 18 years of age with hemophilia, the prevalence of obesity was increased for those with severe hemophilia compared to those with mild or moderate hemophilia [8]. Furthermore, when compared to Canadian population data, hemophilic boys who were 2–5 years old tended to have a higher prevalence of overweight and obesity compared to the age-matched Canadian population.…”

Nutritional status of children and adolescents with haemophilia in Basra, Iraq

“…Revel-Vilk et al32 in Canada reported that overweight status and obesity are common among haemophilic boys, especially those who are younger and with more severe disease. As the use of prophylactic therapy was less common in younger boys, it is possible that the reduced activity among young boys affected their weight.…”