Non Alcholic Fatty Liver Disease (NAFLD) in Overweight and Obese Children

Abstract

Background: NAFLD is seen in 3 to 10 % of obese children in the age group 12 to 14 years. NAFLD is an important cause of chronic liver disease. Prevention of obesity and early recognition of NAFLD will significantly deter a morbid disease. Limited data is available regarding pediatric NAFLD in India. Objective: To study the clinical, biochemical, sonographic and histopathologic features in obese and overweight children diagnosed as NAFLD Methods: All children between 2–16 years attending our hospital a tertiary referral centre during April 2010 and Dec 2010 who were categorized as overweight (BMI> 85Th percentile for age)/obese (>95 th percentile for age) according to WHO and International Obesity Task Force Standard were included and evaluated. Results: Forty-three children constituted the study group. Forty nine percent were obese was and 51 % were overweight. Using waist hip ratio 98 % were classified as obese. 67.4 % of children were in the age group 11-16 years. The male female ratio was 1:1.1. Acanthosis nigricans a marker of insulin resistance was seen in 19 girls (82.6%) and 10 boys (50%) (P = 0.004). Hepatomegaly (clinical) was detected in 7/43 (16%). Ultrasound was reported normal in 5 (12%) and fatty liver in 88% of which mild changes 7 (16%), moderate 21 (49%) and severe 10 (23%).Transaminases was normal 44% (19/43),mild elevation 33% and moderate 23 % but none had marked elevation. 37.5 % had hypertriglyceridemia,50 % had hyperinsulinemia and none had hypothyroidism or diabetes. Correlating transaminases and sonographic findings 90 % of those with severe changes had elevated transaminases (P = 0.016). Liver biopsy showed type 1 NASH in 4/5 (80%) and type 2 NASH in 20% with significant correlation between US and enzymes. Probable NASH (sonographic features and elevation of transaminases) was seen in (55.8%) of overweight (30.2%) and obese (25%) children. Conclusions: This study re-emphasizes the prevalence of NAFLD in overweight/obese Indian children. There is a good correlation between ultrasound grading of fatty liver and level of transaminases.