Abstract
Background: There is growing evidence that non-alcoholic fatty liver disease (NAFLD) is a disease affecting not only the liver but also extrahepatic organs. Aim: To investigate whether in youths NAFLD is associated with extrahepatic complications such as subclinical atherosclerosis, cardiac abnormalities, hypertension, type 2 diabetes, decreased bone mineral density, renal dysfunction, obstructive sleep apnea, and polycystic ovary syndrome. Methods: We systematically reviewed PubMed; Scopus; Embase; and the Cochrane Library databases up to 28 February 2019 and assessed the quality of studies using the Newcastle-Ottawa Scale. Results: Thirty-five articles were selected for this systematic review: fifteen (4627 participants) evaluated the association of NAFLD with subclinical atherosclerosis; four (969 participants) with cardiac abnormalities; two (550 participants) with hypertension; four (1328 participants) with diabetes; six (523 participants) with low bone mineral density; two (865 participants) with renal dysfunction; one with obstructive sleep apnea; and one with polycystic ovary syndrome. Most studies found that youths with NAFLD have increased features of subclinical atherosclerosis; as well as of cardiac alterations. Limited data were available to endorse a solid estimate of the prevalence of diabetes; low mineral density and renal dysfunction in the pediatric NAFLD population. Conclusion: NAFLD-related intermediate CVD outcomes can occur and be detected early in young populations.
Highlights
Concurrent with the increasing prevalence of obesity, nonalcoholic fatty liver disease (NAFLD) has become a major cause of chronic liver disease in childhood [1]
We revealed a close link in youths between non-alcoholic fatty liver disease (NAFLD), a novel component of metabolic syndrome (MetS), and clinical parameters of subclinical atherosclerosis like increased carotid intima-media thickness (cIMT), arterial stiffness, and endothelial dysfunction, though the strength of the association was mainly investigated by the assessment of cIMT
On the basis of available evidence from cross-sectional studies, youths with NAFLD are more likely to be at risk for early atherosclerotic changes and cardiac alterations, and metabolic derangement.Prospective longitudinal studies are needed to establishthe extent to which pediatric NAFLD and its severity may impact on long-term cardiovascular outcomes in the communitypopulation
Summary
Concurrent with the increasing prevalence of obesity, nonalcoholic fatty liver disease (NAFLD) has become a major cause of chronic liver disease in childhood [1]. Even though NAFLD is associated with increased liver-related mortality and morbidity, cardiovascular mortality is the main cause of death in NAFLD patients [3] This has led to a growing awareness that NAFLD, as part of a spectrum of multiple-organ conditions termed metabolic syndrome (MetS), may be associated. Aim: To investigate whether in youths NAFLD is associated with extrahepatic complications such as subclinical atherosclerosis, cardiac abnormalities, hypertension, type 2 diabetes, decreased bone mineral density, renal dysfunction, obstructive sleep apnea, and polycystic ovary syndrome. Results: Thirty-five articles were selected for this systematic review: fifteen (4627 participants) evaluated the association of NAFLD with subclinical atherosclerosis; four (969 participants) with cardiac abnormalities; two (550 participants) with hypertension; four (1328 participants) with diabetes; six (523 participants) with low bone mineral density; two (865 participants) with renal dysfunction; one with obstructive sleep apnea; and one with polycystic ovary syndrome. Conclusion: NAFLD-related intermediate CVD outcomes can occur and be detected early in young populations
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