Low-resource neighborhoods linked to higher risk for pediatric NAFLD
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WASHINGTON — Children who reside in low-resource neighborhoods may be at increased risk for non-alcoholic fatty liver disease, according to study results presented at The Liver Meeting.
“The analysis does not prove cause and effect, but there certainly is association between where you live — or neighborhood deprivation — and likelihood of having fatty liver disease,” John Bucuvalas, MD, chief of the division of hepatology and vice chair of faculty affairs in the Jack and Lucy Clark Department of Pediatrics at the Icahn School of Medicine at Mount Sinai and Mount Sinai Kravis Children’s Hospital, told Healio. “Whether this reflects resources or food available, family/work demands, availability of places to play and exercise, race/ethnicity or an interaction among these factors is uncertain.”
Bucuvalas and colleagues conducted a retrospective chart review and identified 201 patients, aged 2 to 19 years, who were overweight or obese and diagnosed with NAFLD from April 2009 to October 2020. Patients were included if they resided in New York City and had two ALT values, taken at least 60 days apart, that were greater than age- and gender-appropriate norms.
Researchers grouped patients at the census tract level and calculated the Community Deprivation Index (CDI) for each tract, with 1 being the most severe degree of resource deprivation on a 0 to 1 scale.
According to study results, 67% of the cohort was male, 78% identified as Hispanic and 76.6% had Medicaid as their primary insurance. At diagnosis, the mean ALT was 91.7 U/L. Out of 121 transient elastography procedures, 67.8% of patients had S3 steatosis and 10.7% had F3 or F4 fibrosis. Of 23 biopsies performed, 30.4% had stage 3 or 4 fibrosis.
The mean CDI in the NAFLD cohort was 0.50 vs. 0.39 in New York City and 0.35 nationally.
Although researchers acknowledged that “deeper investigation” is warranted to confirm and expand on these findings, Bucuvalas advises physicians to be aware and conduct patient histories that include discussions about the challenges families face.
“The neighborhood impact is real,” he said, “and exploring resources outside the home is critical to development of an effective plan, especially given that behavior changes are the mainstay of mitigation of the condition.”
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Bucuvalas J, et al. Abstract 116. Pediatric non-alcoholic fatty liver disease: Residing in low-resource neighborhoods may increase risk. Presented at: The Liver Meeting; Nov. 4-8, 2022; Washington (hybrid).
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