Digestive Diseases and Sciences

, Volume 54, Issue 10, pp 2225–2230

Clinical and Histological Features of Nonalcoholic Fatty Liver Disease in Children

  • Jae Sung Ko
  • Jung Min Yoon
  • Hye Ran Yang
  • Jae Kyung Myung
  • Hye Ryeung Kim
  • Gyeong Hoon Kang
  • Jung-Eun Cheon
  • Jeong Kee Seo
Original Article

Abstract

Background

Nonalcoholic fatty liver disease (NAFLD) is becoming more frequently diagnosed as the prevalence of obesity in children increases rapidly.

Aim

The aim of this study was to investigate the correlation of clinical findings with histopathologic features in children with NAFLD.

Methods

We reviewed the clinical data and liver histology results of children with biopsy-proven NAFLD at Seoul National University Hospital. NAFLD was classified as simple steatosis, type 1 nonalcoholic steatohepatitis (NASH), characterized by ballooning degeneration and perisinusoidal fibrosis, or type 2 NASH, characterized by portal inflammation and portal fibrosis.

Results

Among 80 total patients, 84% were male. All patients were obese or overweight. Insulin resistance was present in 96% of children. Perisinusoidal fibrosis was noted in 45% of children and portal fibrosis was noted in 77%. Simple steatosis was present in 22% of children, type 1 NASH in 34%, and type 2 NASH in 44%. No differences were found among NAFLD subtypes or NAFLD activity score with regard to sex, blood pressure, or levels of aminotransferase, fasting lipid, or insulin. Children with NASH were older and had higher body mass index than those with simple steatosis. Patients with type 2 NASH had higher body mass index and advanced fibrosis compared with patients with type 1 NASH.

Conclusions

Obesity and older age are associated with development of NASH. Type 2 NASH is the most common form and associated with a greater severity of obesity and advanced fibrosis.

Keywords

Fatty liver disease Obesity Histology Child 

References

  1. 1.
    Hubscher SG. Histological assessment of non-alcoholic fatty liver disease. Histopathology. 2006;49:450–465.PubMedCrossRefGoogle Scholar
  2. 2.
    Schwimmer JB, Deutsch R, Kahen T, et al. Prevalence of fatty liver in children and adolescents. Pediatrics. 2006;118:1388–1393.PubMedCrossRefGoogle Scholar
  3. 3.
    Tominaga K, Kurata JH, Chen YK, et al. Prevalence of fatty liver in Japanese children and relationship to obesity. An epidemiological ultrasonographic survey. Dig Dis Sci. 1995;40:2002–2009.PubMedCrossRefGoogle Scholar
  4. 4.
    Park HS, Han JH, Choi KM, et al. Relation between elevated serum alanine aminotransferase and metabolic syndrome in Korean children. Am J Clin Nutr. 2005;82:1046–1051.PubMedGoogle Scholar
  5. 5.
    Papandreou D, Rousso I, Mavromichalis I. Update on non-alcoholic fatty liver disease in children. Clin Nutr. 2007;26:409–415.PubMedCrossRefGoogle Scholar
  6. 6.
    Ludwig J, Viggiano TR, McGill DB, et al. Nonalcoholic steatohepatitis: Mayo clinic experiences with a hitherto unnamed disease. Mayo Clin Proc. 1980;55:434–438.PubMedGoogle Scholar
  7. 7.
    Brunt EM, Janney CG, Di Bisceglie AM, et al. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94:2467–2474.PubMedCrossRefGoogle Scholar
  8. 8.
    Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313–1321.PubMedCrossRefGoogle Scholar
  9. 9.
    Schwimmer JB, Behling C, Newbury R, et al. Histopathology of pediatric nonalcoholic fatty liver disease. Hepatology. 2005;42:641–649.PubMedCrossRefGoogle Scholar
  10. 10.
    Moon JS, Nam CM, Choi JM, et al. 2007 Korean national growth charts: review of developmental process and an outlook. Korean J Pediatr. 2008;51:1–25.CrossRefGoogle Scholar
  11. 11.
    Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–419.PubMedCrossRefGoogle Scholar
  12. 12.
    Skelly MM, James PD, Ryder SD. Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology. J Hepatol. 2001;35:195–199.PubMedCrossRefGoogle Scholar
  13. 13.
    de Ledinghen V, Combes M, Trouette H, et al. Should a liver biopsy be done in patients with subclinical chronically elevated transaminases? Eur J Gastroenterol Hepatol. 2004;16:879–883.PubMedCrossRefGoogle Scholar
  14. 14.
    Caldwell SH, Oelsner DH, Iezzoni JC, et al. Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. Hepatology. 1999;29:664–669.PubMedCrossRefGoogle Scholar
  15. 15.
    McCullough AJ. The clinical features, diagnosis and natural history of nonalcoholic fatty liver disease. Clin Liver Dis. 2004;8:521–533.PubMedCrossRefGoogle Scholar
  16. 16.
    Nobili V, Marcellini M, Devito R, et al. NAFLD in children: a prospective clinical-pathological study and effect of lifestyle advice. Hepatology. 2006;44:458–465.PubMedCrossRefGoogle Scholar
  17. 17.
    Patton HM, Lavine JE, Van Natta ML, et al. Clinical correlates of histopathology in pediatric nonalcoholic steatohepatitis. Gastroenterology. 2008;135:1961–1971.PubMedCrossRefGoogle Scholar
  18. 18.
    Chitturi S, Abeygunasekera S, Farrell GC, et al. NASH and insulin resistance: insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology. 2002;35:373–379.PubMedCrossRefGoogle Scholar
  19. 19.
    Garcia-Monzon C, Martin-Perez E, Iacono OL, et al. Characterization of pathogenic and prognostic factors of nonalcoholic steatohepatitis associated with obesity. J Hepatol. 2000;33:716–724.PubMedCrossRefGoogle Scholar
  20. 20.
    Schwimmer JB, Deutsch R, Rauch JB, et al. Obesity, insulin resistance, and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease. J Pediatr. 2003;143:500–505.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Jae Sung Ko
    • 1
  • Jung Min Yoon
    • 1
  • Hye Ran Yang
    • 1
  • Jae Kyung Myung
    • 2
  • Hye Ryeung Kim
    • 2
  • Gyeong Hoon Kang
    • 2
  • Jung-Eun Cheon
    • 3
  • Jeong Kee Seo
    • 1
  1. 1.Department of PediatricsSeoul National University College of MedicineJongrogu, SeoulKorea
  2. 2.Department of PathologySeoul National University College of MedicineJongrogu, SeoulKorea
  3. 3.Department of RadiologySeoul National University College of MedicineJongrogu, SeoulKorea

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