Younger children present with more severe NASH than adolescents

Children diagnosed with non-alcoholic fatty liver disease between the ages 7 and 12 years presented with worse steatohepatitis and other factors than their teen counterparts, according to study results presented at Emerging Trends in Non-Alcoholic Fatty Liver Disease.

“We concluded in this study that NASH is more severe in younger children compared to adolescents and this is independent to any difference in gender, obesity, ethnicity, BMI z-score and waist-to-circumference percentile,” Rehan Abdou, MD, from the University at Buffalo Digestive Diseases and Nutrition Center and Women and Children’s Hospital of Buffalo, said during her presentation. “We also concluded that younger children are also more likely to have zone 1 NASH compared to zone 3 in older ones.”

Abdou’s analysis included 134 children from age 7 years to age 18 years with overweight and obesity who also had biopsy-proven NAFLD (ages 7-12 years, n = 56; age 13, n = 78).

While there was little difference in BMI or waist circumference percentiles, Abdou showed significant difference between the age groups for blood pressure stage, LDL, tryglycerides, HDL and insulin resistance.

“When we assessed metabolic syndrome features, it was really a great difference between younger children and older ones with adolescents having more features of metabolic syndrome,” she said.

She also showed that while 67.9% of adolescents showed mild portal inflammation as compared to 41.1% of the younger group, the reverse was true for moderate portal inflammation. In the younger group, 46.4% had moderate portal inflammation while just 25.6% of the adolescents presented with moderate grading.

Bridging fibrosis showed a similar cause for concern, Abdou said. In the adolescent group, just 16.7% presented with bridging fibrosis while 33.3% of the younger group had bridging fibrosis.

“Younger children had some correlation through anthropometric measurements including the waist circumference and height and BMI z-score with hepatic injury but we couldn’t find this in adolescents. This observation might be the key that the onset of obesity could be the determining factor of NASH severity in this age group,” Abdou said.

Though there is no obvious answer for why younger children seem more affected by NAFLD than their adolescent counterparts, Abdou said it could be due to a more active hedgehog pathway or the more quickly developing liver.

“Given the fact that NASH is more severe in younger children emphasizes the importance of augmenting the effort to prevent and manage early childhood obesity,” she said. “We propose to include the onset of obesity in our assessment of children with NAFLD and the most important question here is: does NAFLD get better as younger children progress to adolescence?” – by Katrina Altersitz

Reference:

Abdou R. Steatosis, portal inflammation and fibrosis are more advanced in younger children with NAFLD. Presented at: Emerging Trends in Non-Alcoholic Fatty Liver Disease; March 18-19, 2017; Washington.

Disclosure: Abdou reports no relevant financial disclosures.