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NAFLD in children linked to lower bone mineral density

Researchers identified a link between the presence and severity of nonalcoholic fatty liver disease in children with reduced whole-body bone mineral density, according to results of a systematic review and meta-analysis.

“Currently, lifestyle modifications to improve diet and increase physical activity are recommended as the first-line treatment for all children and adolescents with NAFLD,” Alessandro Mantovani, MD, from the Integrated University Hospital in Verona, Italy, and colleagues wrote. “Based on the findings of our meta-analysis, we believe that another good reason to further reinforce the utility of these nonpharmacological treatments for NAFLD is that increased physical activity in children with NAFLD not only has positive metabolic effects on the liver but may also exert beneficial effects on bone health.”

Mantovani and colleagues included eight observational studies published between January 2000 and September 2018 in their analysis. The studies reported data on 632 children and adolescents with a mean age of 12.8 years and a mean BMI of 29.6 kg/m².

The analysis revealed significantly lower bone mineral density (BMD) z scores in pediatric patients than those without NAFLD (pooled weighted mean difference, or WMD = –0.48; 95% CI, –0.74 to –0.21; I² = 55.5%).

This difference was consistent for both whole body BMD (pooled WMD = –0.31; 95% CI, –0.57 to –0.05; I² = 29%) and lumbar BMD (pooled WMD = –0.79; 95% CI, –1.06 to –0.51; I² = 0%). The researchers also found that BMD z scores were significantly lower in pediatric patients with NASH than those without NASH (pooled WMD = –0.27; 95% CI, –0.4 to –0.13; I² = 0%).

Stratifying the studies by country, method used for diagnosing NAFLD, and increasing absolute values of BMD z scores showed that the significant differences in BMD z scores between patients with and without NAFLD were consistent for all studies.

Mantovani and colleagues noted that the cross-sectional design of the included studies did not allow them to establish temporality and causality of the correlation between fatty liver disease and BMD, but that the results support considering measurement of BMD z scores in pediatric patients with NAFLD.

“These findings suggest that overweight/obese adolescents with NAFLD should be screened for low BMD (given their increased risk of developing osteoporosis and pathologic fractures in adulthood) and that NAFLD should be looked for in all overweight/obese adolescents with low BMD, given that these subjects are at higher risk of NASH,” the investigators concluded. – by Talitha Bennett

Disclosures: The authors report no relevant financial disclosures.