Nonalcoholic Steato-hepatitis Associated with Childhood Obesity

Abstract

Gastroenterology and Nutrition| August 01 2000 Nonalcoholic Steato-hepatitis Associated with Childhood Obesity AAP Grand Rounds (2000) 4 (2): 11. https://doi.org/10.1542/gr.4-2-11 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share MailTo Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Nonalcoholic Steato-hepatitis Associated with Childhood Obesity. AAP Grand Rounds August 2000; 4 (2): 11. https://doi.org/10.1542/gr.4-2-11 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: childhood obesity, hepatitis, steatohepatitis, non-alcoholic, obesity Source: Rashid M, Roberts EA.Nonalcoholic steatohepatitis in children. J Pediatr Gastroenterol Nutr. 2000;30:48–53. Non-alcoholic steatohepatitis (NASH) occurs commonly in adults in association with obesity, hyperlipidemia, and adult onset diabetes mellitus1 and is known to be a cause of hepatic fibrosis and cirrhosis.2,3 The natural history and clinical presentation of NASH in children and adolescents is unknown. Rashid and Roberts report their 10-year experience of 36 children (21 male, 15 female) diagnosed with NASH. The median age was 12 years with a range of 4–16 years of age. Thirty patients (83%) were obese, with a mean weight of 147% of ideal body weight. Two patients had diabetes mellitus at the time of diagnosis, while 2 more later developed diabetes mellitus. Thirteen of 36 (36%) had acanthosis nigricans (all but one was obese). Thirty-three of 36 patients (92%) had elevated ALT values (mean 179 +/− 31 U/L with normal <40 U/L) although none of the 36 patients had signs or symptoms of chronic liver disease. Hypercholesterolemia (7/36) and hypertriglyc-eridemia (11/36) were relatively common features of NASH. Hepatic ultrasound was obtained in 31 patients, and 24 (77%) showed abnormalities including hepatomegaly and increased echogenicity suggestive of fatty infiltration. Liver biopsy was performed in 24 patients and all patients had significant macrovesicular lipid deposition. Inflammation was present in 88%, and fibrosis/cirrhosis in 75%. One 10-year-old patient had significant cirrhosis noted at biopsy. There were no predictive indicators separating the fibrosis/cirrhosis group from those children who did not have fibrosis at time of biopsy. In the follow-up of 21 patients it was noted that 6 patients lost weight and all of these patients had improvements in the AST level with normalization of values in 2 patients. This report is a sobering reminder that obesity may be associated with the potentially life-threatening consequences of NASH although the long-term prognosis in children with this disorder remains unknown. The presence of hepatomegaly, hyperglycemia, abnormal liver enzymes, acanthosis nigricans, hyperlipidemia, and/or an abnormal hepatic ultrasound in an obese child/adolescent should prompt consideration of liver biopsy and aggressive dietary and behavioral/lifestyle intervention to lose weight. Several “take-home” messages need to be heeded: 1) obesity-associated NASH does occur in children and may be associated with significant liver disease; 2) acanthosis nigricans is a cutaneous marker of potential hyperinsulinemia and may be associated with NASH; 3) an abnormal ultrasound of the liver (enlargement and/or increased echogenicity) in an obese patient should trigger consideration of NASH; 4) an abnormal liver ultrasound cannot separate those patients with and without hepatic fibrosis/cirrhosis – only a liver biopsy can do this; 5) liver enzymes do not predict fibrosis and/or cirrhosis in patients with NASH; 6) weight loss can improve obesity-associated NASH; 7) although NASH does occur in non-obese children, its prevalence is increased in obesity and should be considered in all obese children. This report provides further evidence supporting aggressive therapeutic measures with respect to early weight control in children. Although only a small number of... You do not currently have access to this content.