NAFLD in children: A prospective clinical-pathological... : Hepatology (original) (raw)

Liver Failure and Liver Disease: Liver Disease

NAFLD in children: A prospective clinical-pathological study and effect of lifestyle advice

Nobili, Valerio1,*; Marcellini, Matilde1; Devito, Rita2; Ciampalini, Paolo3; Piemonte, Fiorella4; Comparcola, Donatella1; Sartorelli, Maria Rita1; Angulo, Paul5

1_Liver Unit, Bambino Gesù Children's Hospital, Rome, Italy_

2_Department of Pathology, Bambino Gesù Children's Hospital, Rome, Italy_

3_Department of Endocrinology, Bambino Gesù Children's Hospital, Rome, Italy_

4_Department of Molecular Medicine, Bambino Gesù Children's Hospital, Rome, Italy_

5_Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN_

*Liver Unit, Research Institute, Bambino Gesù Children's Hospital, S. Onofrio 4 Square, 00165 Rome, Italy

Email:[email protected]

Received 9 November 2005; Accepted 2 May 2006

Published online in Wiley InterScience (www.interscience.wiley.com).

Potential conflict of interest: Nothing to report.

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Abstract

Nonalcoholic fatty liver disease (NAFLD), a common cause of chronic liver disease in adults, is incompletely characterized in children. We conducted a prospective study to better characterize the clinical presentation of NAFLD in children and to determine the effect of lifestyle advice in the management of pediatric NAFLD. From June 2001 to April 2003, 84 children (age 3-18.8 yr) who had elevated aminotransferases and the diagnosis of NAFLD confirmed via liver biopsy underwent a 2-hour oral glucose tolerance test and a 12-month program of lifestyle advice consisting of diet and physical exercise. Thirty-four (40.5%) patients were obese (body mass index [BMI] >97th percentile), and 43 (51.2%) were overweight (BMI 85th-97th percentile). Ten (12%) had abnormal glucose tolerance; 10 (12%) had elevated triglycerides, cholesterol, or both; and all had normal blood pressure. Most children (67/84, 80%) were insulin-resistant, including the 7 children with normal BMI (<85th percentile). Increased liver fibrosis was present in 49 (58.1%) patients and was independently associated with obesity (OR 2.7, 95% CI 1.2-6.2) and age (1-year increase; OR 1.2, 95% CI 1.04-1.5). A 12-month program with diet and physical exercise resulted in a significant decrease in BMI, and levels of fasting glucose, insulin, lipids, and liver enzymes, as well as liver echogenicity on ultrasonography. In conclusion , children with NAFLD are almost always insulin-resistant regardless of BMI. Obesity and older age are independently associated with increased liver fibrosis. A simple lifestyle advice program significantly improves insulin resistance, and the liver disease in pediatric NAFLD.