The association between retinal microvascular changes, metabolic risk factors, and liver histology in pediatric patients with non-alcoholic fatty liver disease (NAFLD)



The prevalence of childhood obesity is increasing worldwide. Studies in adult populations show that retinal microvascular changes are associated with obesity and components of the metabolic syndrome. In our study we have assessed the effect of body mass index (BMI), metabolic parameters, and adiposity on the retinal microvasculature in children.


Fifty-four consecutive children with biopsy-proven NAFLD were enrolled in this study. Anthropometric and laboratory parameters were obtained using standardized protocols. Retinal caliber was quantified from digital retinal images using well-known computer-based programs. Twenty-four-hour ambulatory blood pressure monitoring was measured using a standard protocol.


In our population, the prevalence of retinopathy was of 53 % (13 males). The 29 patients with retinopathy (mean age 10.91 ± 3.10) showed significantly higher values of triglycerides (mg/day) (105.57 vs. 90.20, p = 0.04), basal insulin (mUI/ml) (17.20 vs. 12.97, p = 0.02), and HOMA-IR (3.37 vs. 2.76, p = 0.04). The patients with a HOMA-IR >2.5 (OR = 3.34, p = 0.02; 95 % IC, 1.07–10.39), and systolic non-dipping (OR 4.16, p = 0.028, 95 % IC, 1.11–13.67), have an increased risk of retinopathy. Moreover, the study of correlation between all stages of liver biopsy (CRN criteria) and the grade of retinopathy showed a positive correlation with fibrosis (r = 0.31) and an NAS score (r = 0.28).


We found an association between metabolic parameters and nocturnal blood pressure on the retinal microvasculature among the obese children with NAFLD. Furthermore, for the first time, we report the positive relationship between hepatic fibrosis in pediatric NAFLD patients and the degree of retinopathy signs.

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The following authors were involved in the different stages of manuscript writing: study guarantor: V.N; study concept and design: V.N., D.L., L.B, A.M; acquisition of clinical data: D.L., A.M, S.P, P.V, U.G, A.G.A.M, S.P, L.B, V.N and drafting of the manuscript: D.L, A.M, L.B, V.N. No authors received any funding for this manuscript. All the authors certify to have participated sufficiently in the conception and design of this work as well as in the writing of the manuscript to take public responsibility for it. Neither this manuscript nor one with substantially similar content under our authorship has been published or is being considered for publication elsewhere. If requested, we will produce the data on which the manuscript is based for examination by the editors or their assignees.

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Correspondence to Valerio Nobili.

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Liccardo, D., Mosca, A., Petroni, S. et al. The association between retinal microvascular changes, metabolic risk factors, and liver histology in pediatric patients with non-alcoholic fatty liver disease (NAFLD). J Gastroenterol 50, 903–912 (2015).

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  • Non-alcoholic fatty liver disease
  • Obesity
  • Hypertensive retinopathy
  • Metabolic syndrome
  • Microvascular complications