SA Xanthakos et al. Gastroenterol 2020; 159: 159: 1731-1751. Progression of Fatty Liver Disease in Children Receiving Standard of Care Lifestyle Advice
This prospective study followed the natural history of NAFLD in children with timed liver biopsy reassessment in children (n=122) using the placebo arms of 2 large multicenter clinical trials; patients received standard of care lifestyle advice. The study population had a mean age of 13 years; 71% were Hispanic participants
Key findings:
- At enrollment, 31% of the children had definite NASH, 34% had borderline zone 1 NASH, 13% had borderline zone 3 NASH, and 21% had fatty liver but not NASH
- Over a mean period of 1.6 ± 0.4 years, borderline or definite NASH resolved in 29% of the children, whereas 18% of the children with fatty liver or borderline NASH developed definite NASH
- Fibrosis improved in 34% of the children but worsened in 23%
- Progression was more likely with increasing ALT, increasing GGT, type 2 diabetes/increasing HgbA1c
- Overall, one-third had histologic features of progression within 2 years, in association with increasing obesity and serum levels of aminotransferases and loss of glucose homeostasis.
- The study conclusions are limited by selection bias, potential liver biopsy sampling errors, limited enrollment of non-Hispanic children, and relatively short duration of follow-up
Related blog posts:
- Bad Fatty Liver Disease Can Get Worse Quickly
- Fatty Liver Disease in Children is Increasing
- Genetic Testing for Fatty Liver Disease is Not Ready for Routine Use
- Improving Fatty Liver Disease Nomenclature
- Liver Shorts April 2019 Obesity/NAFLD and alcoholic liver disease are driving an increase in HCC and liver cancer mortality
- Pediatric NAFLD: You Don’t Have to be Obese/Overweight to have Fatty Liver Disease (but it helps)
- Should Teenagers with Severe NAFLD Undergo Bariatric Surgery?
- Concise Review: Fatty Liver in Pediatrics
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