THE NATURAL HISTORY OF NONALCOHOLIC FATTY LIVER DISEASE IN CHILDREN: A FOLLOW-UP STUDY FOR UP TO 20-YEARS

By A. Feldstein, P. Charatcharoenwitthaya, S. Treeprasertsuk, J. Benson, Felicity B. Enders, P. Angulo. Gut, 2009

745 citations recorded by the source corpus.

Objectives: The long-term prognosis of non-alcoholic fatty liver disease (NAFLD) in children remains uncertain. We aimed at determining the long-term outcomes and survival of children with NAFLD. Design: Retrospective longitudinal hospital-based cohort study. Patients: Sixty-six children with NAFLD (mean age 13.9 (SD 3.9) years) were followed up for up to 20 years with a total of 409.6 person-years of follow-up. Results: The metabolic syndrome was present in 19 (29%) children at the time of NAFLD diagnosis with 55 (83%) presenting with at least one feature of the metabolic syndrome including obesity, hypertension, dyslipidaemia and/or hyperglycaemia. Four children with baseline normal fasting glucose developed type 2 diabetes 4–11 years after NAFLD diagnosis. A total of 13 liver biopsies were obtained from five patients over a mean of 41.4 (SD 28.8) months showing progression of fibrosis stage in four children. During follow-up, two children died and two underwent liver transplantation for decompensated cirrhosis. The observed survival free of liver transplantation was significantly shorter in the NAFLD cohort as compared to the expected survival in the general United States population of the same age and sex (log-rank test, p<0.00001), with a standardised mortality ratio of 13.6 (95% confidence interval, 3.8 to 34.8). NAFLD recurred in the allograft in the two cases transplanted, with one patient progressing to cirrhosis and requiring re-transplantation. Conclusions: Children with NAFLD may develop end-stage liver disease with the consequent need for liver transplantation. NAFLD in children seen in a tertiary care centre may be associated with a significantly shorter survival as compared to the general population.

Subfields: Endocrinology, Diabetes and Metabolism, Epidemiology, Hepatology

View Paper: https://www.semanticscholar.org/paper/054b31a4142aee4950792f27d5b60c8e861546fe

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Endocrinology, Diabetes and Metabolism

1. Z. Younossi
2. M. Rinella
3. K. Cusi
4. A. Sanyal
5. R. Loomba

In Epidemiology

1. Z. Younossi
2. M. Rinella
3. A. Sanyal
4. K. Cusi
5. E. Brunt
6. J. Lavine
7. N. Chalasani
8. S. Harrison

In Hepatology

1. Z. Younossi
2. M. Rinella
3. K. Cusi
4. A. Sanyal
5. E. Brunt
6. J. Clark
7. R. Loomba
8. Megan H. Bair-Merritt

Citations in the corpus

• Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment (2017, background): “The spectrum of NAFLD can range from simple steatosis to progressive steatohepatitis and cirrhosis.(87,88) Nonalcoholic fatty liver disease is now the most common cause of liver disease in children.”
• Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years (2010, background): “As a result, patients with NAFLD have increased mortality and morbidity compared with the general population.”
• The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases (2018, background): “A retrospective single center report described the natural history of NAFLD in 66 children.((269)) Only 5 had serial biopsies, obtained for unspecified reasons over varying intervals, averaging 41 months between biopsies.”