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Portal inflammation increases complications in children with NAFLD

Children with nonalcoholic fatty liver disease and portal inflammation had increased risk for hepatic and metabolic complications, such as fibrosis and obesity, according to published findings.

“At present, there is a paucity of data on the impact of the different types of NAFLD on the severity of fibrosis and metabolic syndrome in children with NAFLD. Our cross-sectional study, the largest cohort of well-defined, biopsy-proven pediatric NAFLD in the world, highlights that the presence of portal inflammation is independently associated with severity of the metabolic syndrome, in addition to moderate to severe fibrosis on biopsy,” Jake P. Mann, MD, department of pediatrics, University of Cambridge, and Addenbrooke's Hospital, UK, and colleagues wrote.

Jake P. Mann

Using Kleiner fibrosis stage and the Nonalcoholic Steatohepatitis Clinical Research Network system, researchers analyzed data of 430 Caucasian children aged 2 to 18 years with NAFLD who were referred to Gesu Children’s Hospital, Rome. Patients were divided into three groups by histology: type 1 NAFLD (n = 52), type 2 NAFLD (n = 95) and overlap NAFLD (n = 283).

The goal of the study was to determine factors associated with fibrosis and portal inflammation.

Overall, patients with type 2 had a more severe metabolic phenotype compared with patients with type 1, as well as higher body mass index z score (2 vs. 1.6; P < .0001), waist circumference centile (96th vs. 90th, P < .0001), triglyceride levels (84 vs. 77 mg/dL, P = .01) and lower high-density lipoprotein (46 vs. 60 mg/dL, P = .004).

Patients with overlap NAFLD also had a more severe phenotype compared with type 1 patients. Multivariable ordinal logistic regression analysis showed that portal inflammation on biopsy was the strongest independent factor associated with moderate to severe fibrosis (OR = 3.7; 95% CI, 1.4-5.2), after adjusting for age and sex. Further analysis showed waist circumference centile to be the only noninvasive variable associated with portal inflammation (OR = 2.01; 95% CI, 1.2-3.4).

“Our data highlight that patients with type 2 and overlap NAFLD, in particular portal inflammation and high BMI or waist circumference, may be at increased risk of hepatic or metabolic complications,” the researchers wrote.

The researchers concluded: “Portal inflammation is associated with more advanced pediatric NAFLD and features of the metabolic syndrome. … The presence of portal inflammation is the key factor that identifies children at risk of dyslipidemia, obesity, the metabolic syndrome and hepatic fibrosis on biopsy.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.