Adipose tissue inflammation tied to liver fibrosis in NAFLD children

In children with non-alcoholic fatty liver disease, there is an association between markers of subcutaneous white adipose tissue inflammation and the degree of liver fibrosis, independent of obesity, according to recent findings.

Additionally, the reduced insulin secretion associated with subcutaneous adipose tissue (SAT) fibrosis may play a role in diabetes risk.

The researchers enrolled 33 consecutive pediatric patients presenting with non-alcoholic fatty liver disease (NAFLD) at Bambino Gesú Children’s Hospital and Research Institute in Rome from 2011 to 2012. The mean age of the study participants was 11.6 years.

The researchers measured the patients’ height and weight, and calculated BMI and BMI z scores using reference data. They also measured waist circumference at the highest point of the iliac crest. The mean BMI of the patients was 28.1, with seven categorized as lean, 16 as overweight and 10 obese.

Biopsy samples of abdominal and liver SAT were collected from the patients, and histology and immunohistochemistry assays were conducted on the samples to evaluate inflammation and fibrosis in the adipose tissue and inflammation in the liver.

The researchers found overweight/obese participants had a higher mean fat cell area than the lean participants, and the quantity of crown-like structures (CLS) in adipose tissue was positively correlated with BMI and waist circumference in all patients (P=.01).

Patients with CLS in the SAT samples had significantly higher liver fibrosis scores (1.7 vs. 1.2; P=.04), regardless of BMI. Fibrosis of SAT, as determined through higher levels of collagen, were significantly linked to a lower disposition index (P=.006). Because higher levels of SAT collagen are thought to affect glucose stability, this could indicate that SAT inflammation and fibrosis could be risk factors for insulin resistance and type 2 diabetes, researchers said.

According to the researchers, these findings establish an important connection between SAT inflammation and liver fibrosis in children.

“Our study has established a novel link between subcutaneous adipose inflammation, as

indicated by presence of CLS, and the extent of liver fibrosis in children,” the researchers wrote.
“Nearly half of the children in the present study had CLS in adipose tissue and the number of CLS was positively related to obesity status and adipose cell size.”

Disclosure: The researchers report no relevant financial disclosures.