Pediatric Fatty Liver Disease Study: New York City

A recent autopsy study (DM Fernandes et al. J Pediatr 2018; 200: 174-80) examined nonalcoholic fatty liver disease (NAFLD) in a pediatric cohort of 582 (2-19).  Approximately 75% were in 14-19 years of age and 50% were black; black pediatric patients (n=290) were over-represented in this sample only 25% of the New York population is black or African American based on the 2010 census.

Key findings:

  • Causes of death: 49% homicides, 31% accidents, 10% acute illness, 9% suicide, 1% other
  • Overall, NAFLD was present in 4.5%; this low overall prevalence was due in part to the low rate of NAFLD in black children; only 3 of 290 (1%) had NAFLD and none had nonalcoholic steatohepatitis (NASH)
  • The rate of NAFLD was 7.9% in hispanics and 8.3% in white patients.
  • In this cohort, 36% were overweight or obese.  In this subgroup, 14.1% of hispanics and 14.8% of whites had NAFLD.
  • Overall, NASH was present in 1.7% of the entire cohort.  NASH and fibrosis have been shown in prior studies as the best predictors of disease progression

My take: If black children are not killed by homicide or accidents, it is unlikely that they will die from NAFLD due to its low prevalence.

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