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Mburu AN, Laving A, Macharia WM, Sande J. Prevalence of non-alcoholic fatty liver disease in overweight and obese children seeking ambulatory healthcare in Nairobi, Kenya. BMJ Open Gastroenterol 2023; 10:bmjgast-2022-001044. [PMID: 36796875 PMCID: PMC9936283 DOI: 10.1136/bmjgast-2022-001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND While linked to obesity and associated with an increased cardiovascular morbidity, non-alcoholic fatty liver disease (NAFLD) is an often-asymptomatic cause of chronic liver disease in children. Early detection provides opportunity for interventions to curb progression. Childhood obesity is on the rise in low/middle-income countries, but cause-specific mortality data associated with liver disease are scanty. Establishing the prevalence of NAFLD in overweight and obese Kenyan children would guide in public health policies aimed at early screening and intervention. OBJECTIVES To investigate prevalence of NAFLD in overweight and obese children aged 6-18 years using liver ultrasonography. METHODOLOGY This was a cross-sectional survey. After obtaining informed consent, a questionnaire was administered, and blood pressure (BP) measured. Liver ultrasonography was performed to assess fatty changes. Categorical variables were analysed using frequency and percentages. χ2 test and multiple logistic regression model were used to determine relationship between exposure and outcome variables. RESULTS Prevalence of NAFLD was 26.2% (27/103, 95% CI=18.0% to 35.8%). There was no association between sex and NAFLD (OR1.13, p=0.82; 95% CI=0.4 to 3.2). Obese children were four times more likely to have NAFLD compared with overweight children (OR=4.52, p=0.02; 95% CI=1.4 to 19.0). About 40.8% (n=41) had elevated BP, but there was no association with NAFLD (OR=2.06; p=0.27; 95% CI=0.6 to 7.6). Older children (13-18 years) were more likely to have NAFLD (OR 4.42; p=0.03; 95% CI=1.2 to 17.9). CONCLUSION Prevalence of NAFLD was high in overweight and obese school children in Nairobi. Further studies are needed to identify modifiable risk factors to arrest progression and prevent sequelae.
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Affiliation(s)
- Anne Njeri Mburu
- Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Ahmed Laving
- Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya,Paediatrics and Child Health, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - William M Macharia
- Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Joyce Sande
- Radiology and Imaging Diagnostics, Aga Khan University Hospital, Nairobi, Kenya
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Scapaticci S, D’Adamo E, Mohn A, Chiarelli F, Giannini C. Non-Alcoholic Fatty Liver Disease in Obese Youth With Insulin Resistance and Type 2 Diabetes. Front Endocrinol (Lausanne) 2021; 12:639548. [PMID: 33889132 PMCID: PMC8056131 DOI: 10.3389/fendo.2021.639548] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Currently, Non-Alcoholic Fatty Liver Disease (NAFLD) is the most prevalent form of chronic liver disease in children and adolescents worldwide. Simultaneously to the epidemic spreading of childhood obesity, the rate of affected young has dramatically increased in the last decades with an estimated prevalence of NAFLD of 3%-10% in pediatric subjects in the world. The continuous improvement in NAFLD knowledge has significantly defined several risk factors associated to the natural history of this complex liver alteration. Among them, Insulin Resistance (IR) is certainly one of the main features. As well, not surprisingly, abnormal glucose tolerance (prediabetes and diabetes) is highly prevalent among children/adolescents with biopsy-proven NAFLD. In addition, other factors such as genetic, ethnicity, gender, age, puberty and lifestyle might affect the development and progression of hepatic alterations. However, available data are still lacking to confirm whether IR is a risk factor or a consequence of hepatic steatosis. There is also evidence that NAFLD is the hepatic manifestation of Metabolic Syndrome (MetS). In fact, NAFLD often coexist with central obesity, impaired glucose tolerance, dyslipidemia, and hypertension, which represent the main features of MetS. In this Review, main aspects of the natural history and risk factors of the disease are summarized in children and adolescents. In addition, the most relevant scientific evidence about the association between NAFLD and metabolic dysregulation, focusing on clinical, pathogenetic, and histological implication will be provided with some focuses on the main treatment options.
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Affiliation(s)
| | | | | | | | - Cosimo Giannini
- Department of Pediatrics, University of Chieti, Chieti, Italy
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3
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Kurku H, Atar M, Pirgon Ö, Büyükinan M, Erdem SS, Deniz İ, Gederet YT. Pubertal Status and Gonadal Functions in Obese Boys with Fatty Liver. Metab Syndr Relat Disord 2019; 17:102-107. [PMID: 30614770 DOI: 10.1089/met.2018.0050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In adult studies, obese subjects with nonalcoholic fatty liver disease (NAFLD) have been shown to have poor sperm quality, and lower testosterone and luteinizing hormone levels. The aim of this study was to investigate the pubertal status and gonadal functions in obese boys with NAFLD. MATERIALS AND METHODS The study included 119 obese and 78 nonobese age-matched adolescents. The obese boys were separated into two groups based on the presence (NAFLD group) or absence of liver steatosis with high transaminases (non-NAFLD group). The levels of serum AMH (anti-Mullerian hormone), inhibin B, gonadotropins, total testosterone, lipids, high-sensitivity C-reactive protein, fasting glucose, insulin levels, and aortic intima media thickness were measured in all subjects. RESULTS Of the total 197 children, 174 had reached puberty. There were no significant differences between the groups in respect of testicular sizes and the prevalence of pubertal status among the groups (84.3% of NAFLD vs. 70.6% of non-NAFLD vs. 98.7% of control subjects). No significant differences were found in respect of gonadotropins and AMH levels. Total testosterone levels in the NAFLD group were significantly lower than those of the non-NAFLD obese group (P < 0.001) and the control group (P < 0.001). Inhibin B levels were also significantly lower in all (NAFLD and non-NAFLD) obese groups compared to the control group (P = 0.008). CONCLUSIONS The results of the study demonstrated that diminished testosterone and inhibin B levels occur in pubertal obese boys with NAFLD. No significant differences were detected according to pubertal status, AMH levels, and testicular volumes in the age-matched groups.
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Affiliation(s)
- Hüseyin Kurku
- 1 Department of Biochemistry, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - Müge Atar
- 2 Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Özgür Pirgon
- 2 Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Muammer Büyükinan
- 3 Department of Pediatric Endocrinology and Diabetes and University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - Said Sami Erdem
- 1 Department of Biochemistry, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - İsa Deniz
- 4 Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - Yavuz Turgut Gederet
- 1 Department of Biochemistry, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
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4
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Abstract
The liver and kidneys are often similarly affected by a single disease. This is the case in metabolic, immunological, toxic, and infectious diseases, and in the different congenital malformation syndromes. Also, an enzymatic defect in an otherwise healthy liver or the consequences of advanced liver disease by itself can cause kidney disease as a secondary phenomenon. In this review, we describe numerous pathogenic mechanisms leading to dysfunction or malformations of the liver and kidneys in children. We encourage multidisciplinary management for optimal care. A combined liver-kidney transplantation is sometimes needed.
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5
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Fleet SE, Lefkowitch JH, Lavine JE. Current Concepts in Pediatric Nonalcoholic Fatty Liver Disease. Gastroenterol Clin North Am 2017; 46:217-231. [PMID: 28506362 DOI: 10.1016/j.gtc.2017.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of disease. Its increasing prevalence is a direct result of historically high rates of obesity. Hepatocyte lipid accumulation is the first step in a cascade of metabolic and inflammatory events thought to precipitate NAFLD. Histologic findings provide insight into these events. Lifestyle modification remains the primary therapy in children. Current recommendations include vitamin E treatment in those with biopsy-proven NASH. Trials of novel drugs are ongoing in adults. As efficacy/safety are established, these therapies may be tenable for use in children. At the current time, biopsy-driven histology endpoints are necessary to establish whether future therapies can improve pediatric or adult-type NASH in children.
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Affiliation(s)
- Sarah E Fleet
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Medical Center, 622 West 168th Street, PH17-119, New York, NY 10032, USA
| | - Jay H Lefkowitch
- Department of Pathology, Columbia University Medical Center, 630 West 168th Street, PH 15W 1574, New York, NY 10032, USA
| | - Joel E Lavine
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Medical Center, 622 West 168th Street, PH17-105F, New York, NY 10032, USA.
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6
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Cannito S, Morello E, Bocca C, Foglia B, Benetti E, Novo E, Chiazza F, Rogazzo M, Fantozzi R, Povero D, Sutti S, Bugianesi E, Feldstein AE, Albano E, Collino M, Parola M. Microvesicles released from fat-laden cells promote activation of hepatocellular NLRP3 inflammasome: A pro-inflammatory link between lipotoxicity and non-alcoholic steatohepatitis. PLoS One 2017; 12:e0172575. [PMID: 28249038 PMCID: PMC5331985 DOI: 10.1371/journal.pone.0172575] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 02/07/2017] [Indexed: 02/06/2023] Open
Abstract
Non-Alcoholic Fatty Liver Disease (NAFLD) is a major form of chronic liver disease in the general population in relation to its high prevalence among overweight/obese individuals and patients with diabetes type II or metabolic syndrome. NAFLD can progress to steatohepatitis (NASH), fibrosis and cirrhosis and end-stage of liver disease but mechanisms involved are still incompletely characterized. Within the mechanisms proposed to mediate the progression of NAFLD, lipotoxicity is believed to play a major role. In the present study we provide data suggesting that microvesicles (MVs) released by fat-laden cells undergoing lipotoxicity can activate NLRP3 inflammasome following internalization by either cells of hepatocellular origin or macrophages. Inflammasome activation involves NF-kB-mediated up-regulation of NLRP3, pro-caspase-1 and pro-Interleukin-1, then inflammasome complex formation and Caspase-1 activation leading finally to an increased release of IL-1β. Since the release of MVs from lipotoxic cells and the activation of NLRP3 inflammasome have been reported to occur in vivo in either clinical or experimental NASH, these data suggest a novel rational link between lipotoxicity and increased inflammatory response.
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Affiliation(s)
- Stefania Cannito
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Elisabetta Morello
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Claudia Bocca
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Beatrice Foglia
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Elisa Benetti
- Department of Drug Science and Technology, University of Torino, Torino, Italy
| | - Erica Novo
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Fausto Chiazza
- Department of Drug Science and Technology, University of Torino, Torino, Italy
| | - Mara Rogazzo
- Department of Drug Science and Technology, University of Torino, Torino, Italy
| | - Roberto Fantozzi
- Department of Drug Science and Technology, University of Torino, Torino, Italy
| | - Davide Povero
- Department of Pediatrics, University of California San Diego (UCSD), La Jolla, CA, United States of America
| | - Salvatore Sutti
- Department of Health Sciences and Interdisciplinary Research Center for Autoimmune Diseases, University “Amedeo Avogadro” of East Piedmont, Novara, Italy
| | - Elisabetta Bugianesi
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, Torino, Italy
| | - Ariel E. Feldstein
- Department of Pediatrics, University of California San Diego (UCSD), La Jolla, CA, United States of America
| | - Emanuele Albano
- Department of Health Sciences and Interdisciplinary Research Center for Autoimmune Diseases, University “Amedeo Avogadro” of East Piedmont, Novara, Italy
| | - Massimo Collino
- Department of Drug Science and Technology, University of Torino, Torino, Italy
| | - Maurizio Parola
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
- * E-mail:
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Martin-Calvo N, Moreno-Galarraga L, Martinez-Gonzalez MA. Association between Body Mass Index, Waist-to-Height Ratio and Adiposity in Children: A Systematic Review and Meta-Analysis. Nutrients 2016; 8:nu8080512. [PMID: 27556485 PMCID: PMC4997425 DOI: 10.3390/nu8080512] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/12/2016] [Accepted: 08/15/2016] [Indexed: 12/16/2022] Open
Abstract
Obesity is defined as an abnormal or excessive fat accumulation that may impair health. Dual-energy X-ray absorptiometry (DEXA) has been suggested as the gold standard to define obesity, but because its use is complex and expensive, anthropometric measures such as body mass index (BMI) or the waist-to-height ratio (WtHr) have been used as alternatives. The aim of this study was to review the published literature and investigate the correlation of BMI and WtHr with body fat (BF) measured by DEXA in pediatric populations. References were sought in PubMed/Medline and Embase datasets. Five original articles, published between 2013 and 2015, were finally included in this review. Their sample size ranged from 83 to 5355, and the age of participants ranged from 4.9 to 19 years old. The most frequently reported association measurements were the coefficients of determination (R²), followed by correlation coefficients and least-squares regression coefficients. BF measured by DEXA was strongly correlated with both BMI (R² ranging from 0.32 to 0.91) and WtHr (R² ranging from 0.49 to 0.73). Thus, either BMI or WtHr may be useful to define obesity when more sophisticated techniques are not available. Our systematic review of the available literature found that neither index demonstrated superiority in assessing obesity in children.
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Affiliation(s)
- Nerea Martin-Calvo
- Department of Preventive Medicine and Public Health, University of Navarre, Pamplona 31009, Spain.
- Navarra Institute for Health Research (IdisNa), Pamplona 31008, Spain.
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Institute of Health, Madrid 28029, Spain.
| | - Laura Moreno-Galarraga
- Navarra Institute for Health Research (IdisNa), Pamplona 31008, Spain.
- Department of Pediatrics, Complejo Hospital de Navarra, Pamplona 31008, Spain.
| | - Miguel Angel Martinez-Gonzalez
- Department of Preventive Medicine and Public Health, University of Navarre, Pamplona 31009, Spain.
- Navarra Institute for Health Research (IdisNa), Pamplona 31008, Spain.
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Institute of Health, Madrid 28029, Spain.
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Clemente APG, Netto BDM, de Carvalho-Ferreira JP, da Silveira Campos RM, de Piano Ganen A, Tock L, de Mello MT, Dâmaso AR. Waist circumference as a marker for screening nonalcoholic fatty liver disease in obese adolescents. REVISTA PAULISTA DE PEDIATRIA (ENGLISH EDITION) 2016. [PMID: 26830602 PMCID: PMC4795721 DOI: 10.1016/j.rppede.2015.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: To assess the relationship between the degree of waist circumference (WC) and
nonalcoholic fatty liver disease (NAFLD) in obese adolescents of both genders,
analyzed according to quartiles of WC. Methods: Cross-sectional study that involved 247 obese adolescents aged 12–19 years. Mean
values of the nutritional parameters and serum analyses were compared with the
groups using the independent t-test. Pearson correlation
coefficient was used to determine the relationship of the parameters studied.
Chi-square test for trend was used to determine the relationship between the
prevalence of the NAFLD and WC quartile by gender. Results: NAFLD were presented in 60% of the study participants. Obese adolescents in the
3rd and 4th quartiles of WC presented higher prevalence of NAFLD when compared
with that in the 1st quartile in both genders. The NAFLD patients had
significantly higher values for body weight, BMI (body mass index), BAZ-score
(BMI-for-age z-scores), total fat (% and kg), WC, visceral fat, insulin, insulin
resistance index (HOMA-IR), aspartate aminotransferase and alanine
aminotransferase, when compared with non-NAFLD obese adolescents. Conclusions: In conclusion, the results presented here suggest that an increase in WC can
reliably predict the risk of NAFLD in obese adolescents. This is a low cost and
easy-to-use tool that can help in screening in adolescents.
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Affiliation(s)
| | - Bárbara Dal Molin Netto
- Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | | | | | - Aline de Piano Ganen
- Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Lian Tock
- Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Marco Túlio de Mello
- Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Ana Raimunda Dâmaso
- Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
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9
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[Waist circumference as a marker for screening nonalcoholic fatty liver disease in obese adolescents]. REVISTA PAULISTA DE PEDIATRIA 2015; 34:47-55. [PMID: 26830602 DOI: 10.1016/j.rpped.2015.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 04/20/2015] [Accepted: 05/21/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess the relationship between the degree of waist circumference (WC) and nonalcoholic fatty liver disease (NAFLD) in obese adolescents of both genders, analyzed according to quartiles of WC. METHODS Cross-sectional study that involved 247 obese adolescents aged 12-19 years. Mean values of the nutritional parameters and serum analyses were compared with the groups using the independent t-test. Pearson correlation coefficient was used to determine the relationship of the parameters studied. Chi-square test for trend was used to determine the relationship between the prevalence of the NAFLD and WC quartile by gender. RESULTS NAFLD were presented in 60% of the study participants. Obese adolescents in the 3rd and 4th quartiles of WC presented higher prevalence of NAFLD when compared with that in the 1st quartile in both genders. The NAFLD patients had significantly higher values for body weight, BMI (body mass index), BAZ-score (BMI-for-age z-scores), total fat (% and kg), WC, visceral fat, insulin, insulin resistance index (HOMA-IR), aspartate aminotransferase and alanine aminotransferase, when compared with non-NAFLD obese adolescents. CONCLUSIONS The results presented here suggest that an increase in WC can reliably predict the risk of NAFLD in obese adolescents. This is a low cost and easy-to-use tool that can help in screening in adolescents.
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10
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Povero D, Panera N, Eguchi A, Johnson CD, Papouchado BG, de Araujo Horcel L, Pinatel EM, Alisi A, Nobili V, Feldstein AE. Lipid-induced hepatocyte-derived extracellular vesicles regulate hepatic stellate cell via microRNAs targeting PPAR-γ. Cell Mol Gastroenterol Hepatol 2015; 1:646-663.e4. [PMID: 26783552 PMCID: PMC4714359 DOI: 10.1016/j.jcmgh.2015.07.007] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND&AIMS Hepatic stellate cells (HSCs) play a key role in liver fibrosis in various chronic liver disorders including nonalcoholic fatty liver disease (NAFLD). The development of liver fibrosis requires a phenotypic switch from quiescent to activated HSCs. The triggers for HSCs activation in NAFLD remain poorly understood. We investigated the role and molecular mechanism of extracellular vesicles (EVs) released by hepatocytes during lipotoxicity in modulation of HSC phenotype. METHODS EVs were isolated from fat-laden hepatocytes by differential centrifugation and incubated with HSCs. EV internalization and HSCs activation, migration and proliferation were assessed. Loss- and gain-of-functions studies were performed to explore the potential role of PPAR-γ-targeting miRNAs carried by EVs into HSC. RESULTS Hepatocyte-derived EVs released during lipotoxicity are efficiently internalized by HSCs resulting in their activation, as shown by marked up-regulation of pro-fibrogenic genes (Collagen-I, α-SMA and TIMP-2), proliferation, chemotaxis and wound healing responses. These changes were associated with miRNAs shuttled by EVs and suppression of PPAR-γ expression in HSC. Hepatocyte-derived EVs miRNA content included various miRNAs that are known inhibitors of PPAR-γ expression with miR-128-3p being the most effectively transferred. Furthermore loss- and gain-of-function studies identified miR-128-3p as a central modulator of the effects of EVs on PPAR-γ inhibition and HSC activation. CONCLUSION Our findings demonstrate a link between fat-laden hepatocyte-derived EVs and liver fibrosis and have potential implications for the development of novel anti-fibrotic targets for NAFLD and other fibrotic diseases.
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Affiliation(s)
- Davide Povero
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Nadia Panera
- Hepato-Metabolic Disease Unit and Liver Research Unit, Bambino-Gesu’ Children’s Hospital, Rome, Italy
| | - Akiko Eguchi
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Casey D. Johnson
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | | | - Lucas de Araujo Horcel
- Department of Pediatrics, University of California San Diego, La Jolla, California
- Centro Universitário Lusiada, Santos, Brazil
| | - Eva M. Pinatel
- Institute of Biomedical Technologies, National Research Council, Segrate, Italy
| | - Anna Alisi
- Hepato-Metabolic Disease Unit and Liver Research Unit, Bambino-Gesu’ Children’s Hospital, Rome, Italy
| | - Valerio Nobili
- Hepato-Metabolic Disease Unit and Liver Research Unit, Bambino-Gesu’ Children’s Hospital, Rome, Italy
| | - Ariel E. Feldstein
- Department of Pediatrics, University of California San Diego, La Jolla, California
- Correspondence Address correspondence to: Ariel E. Feldstein, MD, Division of Pediatric Gastroenterology, Hepatology, and Nutrition UCSD, 3020 Children’s Way, MC 5030, San Diego, California 92103–8450.
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11
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Abd El-Kader SM, El-Den Ashmawy EMS. Non-alcoholic fatty liver disease: The diagnosis and management. World J Hepatol 2015; 7:846-858. [PMID: 25937862 PMCID: PMC4411527 DOI: 10.4254/wjh.v7.i6.846] [Citation(s) in RCA: 239] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 11/26/2014] [Accepted: 01/19/2015] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is now the most frequent chronic liver disease that occurs across all age groups and is recognized to occur in 14%-30% of the general population, representing a serious and growing clinical problem due to the growing prevalence of obesity and overweight. Histologically, it resembles alcoholic liver injury but occurs in patients who deny significant alcohol consumption. NAFLD encompasses a spectrum of conditions, ranging from benign hepatocellular steatosis to inflammatory nonalcoholic steatohepatitis, fibrosis, and cirrhosis. The majority of hepatocellular lipids are stored as triglycerides, but other lipid metabolites, such as free fatty acids, cholesterol, and phospholipids, may also be present and play a role in disease progression. NAFLD is associated with obesity and insulin resistance and is considered the hepatic manifestation of the metabolic syndrome, a combination of medical conditions including type 2 diabetes mellitus, hypertension, hyperlipidemia, and visceral adiposity. Confirmation of the diagnosis of NAFLD can usually be achieved by imaging studies; however, staging the disease requires a liver biopsy. Current treatment relies on weight loss and exercise, although various insulin-sensitizing agents, antioxidants and medications appear promising. The aim of this review is to highlight the current information regarding epidemiology, diagnosis, and management of NAFLD as well as new information about pathogenesis, diagnosis and management of this disease.
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12
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Yeh MM, Brunt EM. Pathological features of fatty liver disease. Gastroenterology 2014; 147:754-64. [PMID: 25109884 DOI: 10.1053/j.gastro.2014.07.056] [Citation(s) in RCA: 219] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 07/23/2014] [Accepted: 07/25/2014] [Indexed: 12/13/2022]
Abstract
Alcoholic liver disease (ALD) and nonalcoholic fatty liver disease (NAFLD) are significant causes of chronic liver disease worldwide. Both are characterized by histological lesions that can include steatosis, and each can lead to cirrhosis. It might be possible for pathologists to identify lesions and patterns of ALD and NAFLD; we review these lesions and propose methods to distinguish between the disorders. Any form of ALD can lead to end-stage liver disease, according to long-term studies of biopsy specimens and patient outcomes. Although steatosis can be a significant cofactor in progression of established chronic liver disease, or even development of hepatocellular carcinoma, only steatohepatitis indicates the presence of progressive liver disease in patients with NAFLD. Pediatric and adolescent NAFLD differ from adult nonalcoholic steatohepatitis and should be recognized as distinct conditions. Benign and malignant liver tumors have been more frequently reported with the increasing prevalence of obesity and diabetes. Histological scoring systems for ALD and NAFLD have been proposed to monitor efficacy in clinical trials and serve as prognostic factors. We review what we have learned from pathological analyses about the development of these disorders and how this information might be used to detect and treat them.
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Affiliation(s)
- Matthew M Yeh
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Elizabeth M Brunt
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.
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13
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Novel association between a nonsynonymous variant (R270H) of the G-protein-coupled receptor 120 and liver injury in children and adolescents with obesity. J Pediatr Gastroenterol Nutr 2014; 59:472-5. [PMID: 25250621 DOI: 10.1097/mpg.0000000000000463] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The G-protein-coupled receptor 120 (GPR120) is a receptor for polyunsaturated fatty acids with anti-inflammatory activity. The R270H variant of GPR120 enhances inflammation in adipose and hepatic tissues. We investigated whether the R270H variant could play a role in determining liver injury in children and adolescents with obesity. Five hundred eighty-one children with obesity were studied. No homozygotes and 20 heterozygotes for the 270H allele were found. Heterozygotes showed higher alanine transaminase (ALT) levels (P = 0.01) than wild-type subjects, and also showed an odds ratio to have pathologic ALT of 3.2 (95% confidence interval [CI] 1.2-8.0, P < 0.05). Moreover, we genotyped the same patients for the patatin-like phospholipase-containing domain 3 (PNPLA3) I148M polymorphism, which is implicated in the development of liver steatosis. Stratifying the patients with the GPR120 270H variant on the basis of their PNPLA3 polymorphism, we demonstrated a significant interaction effect on ALT levels (P = 0.00001), suggesting a driving effect of the PNPLA3 148M allele on liver injury in children with obesity carrying this variant.
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Non-alcoholic Fatty liver disease in children. CURRENT HEALTH SCIENCES JOURNAL 2014; 40:170-6. [PMID: 25729601 PMCID: PMC4340436 DOI: 10.12865/chsj.40.03.03] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 06/10/2014] [Indexed: 02/07/2023]
Abstract
In the last years, there has been extremely much information which reveals an alarming increase of obesity in children and, at the same time, an increase of the incidence of non-alcoholic fatty liver disease (NAFLD). NAFLD implies a wide range of affections starting from simple hepatic steatosis to non-alcoholic steatohepatitis (NASH); the latter can evolve to cirrhosis and hepatic carcinoma. All these affections were noticed in children, too. The article presents data on the epidemiology, pathogeny, clinical and paraclinical findings, and treatment of NAFLD in children.
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Gobato AO, Vasques ACJ, Yamada RM, Zambon MP, Barros-Filho ADA, Hessel G. Biochemical, anthropometric and body composition indicators as predictors of hepatic steatosis in obese adolescents. REVISTA PAULISTA DE PEDIATRIA 2014; 32:230-6. [PMID: 25119755 PMCID: PMC4183024 DOI: 10.1590/0103-0582201432215813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/17/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE: To describe the prevalence of hepatic steatosis and to assess the performance of
biochemical, anthropometric and body composition indicators for hepatic steatosis
in obese teenagers. METHODS: Cross-sectional study including 79 adolecents aged from ten to 18 years old.
Hepatic steatosis was diagnosed by abdominal ultrasound in case of moderate or
intense hepatorenal contrast and/or a difference in the histogram ≥7 on the right
kidney cortex. The insulin resistance was determined by the Homeostasis Model
Assessment-Insulin Resistance (HOMA-IR) index for values >3.16. Anthropometric
and body composition indicators consisted of body mass index, body fat percentage,
abdominal circumference and subcutaneous fat. Fasting glycemia and insulin, lipid
profile and hepatic enzymes, such as aspartate aminotransferase, alanine
aminotransferase, gamma-glutamyltransferase and alkaline phosphatase, were also
evaluated. In order to assess the performance of these indicators in the diagnosis
of hepatic steatosis in teenagers, a ROC curve analysis was applied. RESULTS: Hepatic steatosis was found in 20% of the patients and insulin resistance, in
29%. Gamma-glutamyltransferase and HOMA-IR were good indicators for predicting
hepatic steatosis, with a cutoff of 1.06 times above the reference value for
gamma-glutamyltransferase and 3.28 times for the HOMA-IR. The anthropometric
indicators, the body fat percentage, the lipid profile, the glycemia and the
aspartate aminotransferase did not present significant associations. CONCLUSIONS: Patients with high gamma-glutamyltransferase level and/or HOMA-IR should be
submitted to abdominal ultrasound examination due to the increased chance of
having hepatic steatosis.
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MRI Steatosis Grading: Development and Initial Validation of a Color Mapping System. AJR Am J Roentgenol 2012; 198:582-8. [DOI: 10.2214/ajr.11.6729] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Giudice EMD, Grandone A, Cirillo G, Santoro N, Amato A, Brienza C, Savarese P, Marzuillo P, Perrone L. The association of PNPLA3 variants with liver enzymes in childhood obesity is driven by the interaction with abdominal fat. PLoS One 2011; 6:e27933. [PMID: 22140488 PMCID: PMC3225386 DOI: 10.1371/journal.pone.0027933] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 10/28/2011] [Indexed: 12/12/2022] Open
Abstract
Background and Aims A polymorphism in adiponutrin/patatin-like phospholipase-3 gene (PNPLA3), rs738409 C->G, encoding for the I148M variant, is the strongest genetic determinant of liver fat and ALT levels in adulthood and childhood obesity. Aims of this study were i) to analyse in a large group of obese children the role of the interaction of not-genetic factors such as BMI, waist circumference (W/Hr) and insulin resistance (HOMA-IR) in exposing the association between the I148M polymorphism and ALT levels and ii) to stratify the individual risk of these children to have liver injury on the basis of this gene-environment interaction. Methods 1048 Italian obese children were investigated. Anthropometric, clinical and metabolic data were collected and the PNPLA3 I148M variant genotyped. Results Children carrying the 148M allele showed higher ALT and AST levels (p = 0.000006 and p = 0.0002, respectively). Relationships between BMI-SDS, HOMA-IR and W/Hr with ALT were analysed in function of the different PNPLA3 genotypes. Children 148M homozygous showed a stronger correlation between ALT and W/Hr than those carrying the other genotypes (p: 0.0045) and, therefore, 148M homozygotes with high extent of abdominal fat (W/Hr above 0.62) had the highest OR (4.9, 95% C. I. 3.2–7.8, p = 0.00001) to develop pathologic ALT. Conclusions We have i) showed for the first time that the magnitude of the association of PNPLA3 with liver enzymes is driven by the size of abdominal fat and ii) stratified the individual risk to develop liver damage on the basis of the interaction between the PNPLA3 genotype and abdominal fat.
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Leptin and adiponectin in obese children with and without fatty liver disease. EGYPTIAN LIVER JOURNAL 2011. [DOI: 10.1097/01.elx.0000403698.57283.fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Grandone A, del Giudice EM, Cirillo G, Santarpia M, Coppola F, Perrone L, Savarese P, Marzuillo P, Perrone L. Prepubertal gynecomastia in two monozygotic twins with Peutz-Jeghers syndrome: two years' treatment with anastrozole and genetic study. Horm Res Paediatr 2011; 75:374-9. [PMID: 21335955 DOI: 10.1159/000324178] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 01/07/2011] [Indexed: 12/12/2022] Open
Abstract
Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant disorder characterized by multiple gastrointestinal hamartomatous polyps, mucocutaneous pigmentation and increased predisposition to neoplasms. Endocrine manifestations in PJS include gynecomastia and advanced bone age due to estrogen production by large-cell calcifying Sertoli cell tumors (LSCT). We present two 9-year-old male monozygotic twins, with PJS, bilateral progressive prepubertal gynecomastia and testicular bilateral multifocal calcifications, suggesting a diagnosis of LSCT. Their father had PJS but no history of gynecomastia or testicular calcifications. No mutations were found in the tumor suppressor gene LKB1/STK11, which is responsible for about 60% of PJS cases. The genotype of the aromatase cytochrome P450 19, a key enzyme involved in estrogen biosynthesis, was the same in the father and his twins. To reduce gynecomastia and delay skeletal maturation, the children started treatment with anastrozole, an aromatase inhibitor. Growth velocity decreased and gynecomastia diminished. After 2 years of treatment, anastrozole is still currently used at a dosage of 1 mg once daily with no side effects. In this study, a couple of monozygotic twins with PJS, prepubertal gynecomastia and LSCT is reported for the first time and anastrozole appears to be an efficacious medical treatment, as an alternative to orchidectomy, to control the effects of estrogen excess.
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Affiliation(s)
- Anna Grandone
- Department of Pediatrics F. Fede, Seconda Università degli Studi di Napoli, Naples, Italy.
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Buechler C, Wanninger J, Neumeier M. Adiponectin, a key adipokine in obesity related liver diseases. World J Gastroenterol 2011; 17:2801-11. [PMID: 21734787 PMCID: PMC3120939 DOI: 10.3748/wjg.v17.i23.2801] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 11/17/2010] [Accepted: 11/24/2010] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) comprising hepatic steatosis, non-alcoholic steatohepatitis (NASH), and progressive liver fibrosis is considered the most common liver disease in western countries. Fatty liver is more prevalent in overweight than normal-weight people and liver fat positively correlates with hepatic insulin resistance. Hepatic steatosis is regarded as a benign stage of NAFLD but may progress to NASH in a subgroup of patients. Besides liver biopsy no diagnostic tools to identify patients with NASH are available, and no effective treatment has been established. Visceral obesity is a main risk factor for NAFLD and inappropriate storage of triglycerides in adipocytes and higher concentrations of free fatty acids may add to increased hepatic lipid storage, insulin resistance, and progressive liver damage. Most of the adipose tissue-derived proteins are elevated in obesity and may contribute to systemic inflammation and liver damage. Adiponectin is highly abundant in human serum but its levels are reduced in obesity and are even lower in patients with hepatic steatosis or NASH. Adiponectin antagonizes excess lipid storage in the liver and protects from inflammation and fibrosis. This review aims to give a short survey on NAFLD and the hepatoprotective effects of adiponectin.
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Yap JYK, O'Connor C, Mager DR, Taylor G, Roberts EA. Diagnostic challenges of nonalcoholic fatty liver disease (NAFLD) in children of normal weight. Clin Res Hepatol Gastroenterol 2011; 35:500-5. [PMID: 21600867 DOI: 10.1016/j.clinre.2011.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 04/03/2011] [Accepted: 04/06/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is generally regarded as affecting the overweight or obese. Though previously reported, the notion that NAFLD occurs in the presence of normal body weight (adult BMI<25) is unfamiliar in adults and problematic in children. Normal-body-weight NAFLD accounts for approximately 15% of all NAFLD and may be more prevalent with certain ethnicities. CASE We describe a case of a child who appeared to have normal-body-weight NAFLD, on the basis of typical age of presentation, ultrasonographically evident hepatic steatosis and compatible liver histology, including a NAFLD activity score of 7, but was shown conclusively to have cystic fibrosis. Further we present a clinical strategy for diagnosis of childhood NAFLD, which would discriminate between this patient and actual normal-body-weight NAFLD children in our clinical practice. CONCLUSION NAFLD requires affirmative diagnostic criteria and should not be merely a diagnosis of exclusion.
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Affiliation(s)
- Jason Y K Yap
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
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Tannapfel A, Denk H, Dienes HP, Langner C, Schirmacher P, Trauner M, Flott-Rahmel B. Histopathological diagnosis of non-alcoholic and alcoholic fatty liver disease. VIRCHOWS ARCHIV : AN INTERNATIONAL JOURNAL OF PATHOLOGY 2011. [PMID: 21442288 DOI: 10.1007/s00428-011-1066-1]] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The diagnostic procedures in patients with suspected fatty liver disease-with or without known alcohol consumption-should be standardized and generally accepted. We therefore present a guideline, summarizing the current concepts of etiology, diagnostic as well as differential diagnostic of patients with fatty liver disease. Alcoholic as well as and non-alcoholic fatty liver are characterised by lipid deposition in hepatocytes. The diagnosis of steatosis is made when lipid deposition exceeds 5% of hepatocytes, while involvement of more than 50% is called "fatty liver". An additional inflammatory reaction leads to alcoholic (ASH) or non-alcoholic steatohepatitis (NASH). Steatohepatitis is present when both inflammatory infiltrates of mixed cells in the small liver lobules as well as liver cell injury in terms of ballooning can be detected. Liver biopsy represents the "golden standard" for confirming diagnosis and determining inflammatory activity and potential fibrosis of fatty liver disease. The differential diagnosis of ASH vs. NASH cannot be made on the basis of histological criteria alone. Steatosis, inflammatory changes and hepatocytic injury can be semiquantified as a "Brunt Score" or "NAS" (NAFLD activity score), providing the basis on which to decide whether or not steatohepatitis is present. People at increased risk of developing a fatty liver possess an increased risk of developing chemotherapy-associated steatohepatitis. Histologically, pediatric NASH differs from adult NASH and is often only clinically manifest through a mild if persistent elevation in transaminases.
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Affiliation(s)
- Andrea Tannapfel
- Institut für Pathologie, Ruhr-Universität Bochum, Bürkle-de-la-Camp Platz 1, Bochum, Germany.
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23
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Abstract
The diagnostic procedures in patients with suspected fatty liver disease-with or without known alcohol consumption-should be standardized and generally accepted. We therefore present a guideline, summarizing the current concepts of etiology, diagnostic as well as differential diagnostic of patients with fatty liver disease. Alcoholic as well as and non-alcoholic fatty liver are characterised by lipid deposition in hepatocytes. The diagnosis of steatosis is made when lipid deposition exceeds 5% of hepatocytes, while involvement of more than 50% is called "fatty liver". An additional inflammatory reaction leads to alcoholic (ASH) or non-alcoholic steatohepatitis (NASH). Steatohepatitis is present when both inflammatory infiltrates of mixed cells in the small liver lobules as well as liver cell injury in terms of ballooning can be detected. Liver biopsy represents the "golden standard" for confirming diagnosis and determining inflammatory activity and potential fibrosis of fatty liver disease. The differential diagnosis of ASH vs. NASH cannot be made on the basis of histological criteria alone. Steatosis, inflammatory changes and hepatocytic injury can be semiquantified as a "Brunt Score" or "NAS" (NAFLD activity score), providing the basis on which to decide whether or not steatohepatitis is present. People at increased risk of developing a fatty liver possess an increased risk of developing chemotherapy-associated steatohepatitis. Histologically, pediatric NASH differs from adult NASH and is often only clinically manifest through a mild if persistent elevation in transaminases.
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Histopathological diagnosis of non-alcoholic and alcoholic fatty liver disease. Virchows Arch 2011; 458:511-23. [PMID: 21442288 DOI: 10.1007/s00428-011-1066-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 03/02/2011] [Accepted: 03/08/2011] [Indexed: 02/07/2023]
Abstract
The diagnostic procedures in patients with suspected fatty liver disease-with or without known alcohol consumption-should be standardized and generally accepted. We therefore present a guideline, summarizing the current concepts of etiology, diagnostic as well as differential diagnostic of patients with fatty liver disease. Alcoholic as well as and non-alcoholic fatty liver are characterised by lipid deposition in hepatocytes. The diagnosis of steatosis is made when lipid deposition exceeds 5% of hepatocytes, while involvement of more than 50% is called "fatty liver". An additional inflammatory reaction leads to alcoholic (ASH) or non-alcoholic steatohepatitis (NASH). Steatohepatitis is present when both inflammatory infiltrates of mixed cells in the small liver lobules as well as liver cell injury in terms of ballooning can be detected. Liver biopsy represents the "golden standard" for confirming diagnosis and determining inflammatory activity and potential fibrosis of fatty liver disease. The differential diagnosis of ASH vs. NASH cannot be made on the basis of histological criteria alone. Steatosis, inflammatory changes and hepatocytic injury can be semiquantified as a "Brunt Score" or "NAS" (NAFLD activity score), providing the basis on which to decide whether or not steatohepatitis is present. People at increased risk of developing a fatty liver possess an increased risk of developing chemotherapy-associated steatohepatitis. Histologically, pediatric NASH differs from adult NASH and is often only clinically manifest through a mild if persistent elevation in transaminases.
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Abstract
Histological analysis of liver biopsies remains a standard against which other methods of assessment for the presence and amount of hepatic injury due to nonalcoholic fatty liver disease (NAFLD) are measured. Histological evaluation remains the sole method of distinguishing steatosis from advanced forms of NAFLD, i.e. nonalcoholic steatohepatitis (NASH) and fibrosis. Included in the lesions of NAFLD are steatosis, lobular and portal inflammation, hepatocyte injury in the forms of ballooning and apoptosis, and fibrosis. However, patterns of these lesions are as distinguishing as the lesions themselves. Liver injury in adults and children due to NAFLD may have different histological patterns. In this review, the rationale for liver biopsy, as well as the histopathological lesions, the microscopically observable patterns of injury, and the differential diagnoses of NAFLD and NASH are discussed.
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Cakir M, Bruno C, Cansu A, Cobanoglu U, Erduran E. Liver cirrhosis in an infant with Chanarin-Dorfman syndrome caused by a novel splice-site mutation in ABHD5. Acta Paediatr 2010; 99:1592-4. [PMID: 20528790 DOI: 10.1111/j.1651-2227.2010.01869.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED We described a Turkish girl with Chanarin-Dorfman syndrome who developed liver cirrhosis in the early infancy. She had all the clinical features of Chanarin-Dorfman syndrome such as ichthyosis, Jordan's anomaly, fatty liver disease and mild ectropion. The diagnosis was confirmed with a novel ABHD5 mutation. Liver steatosis or steatohepatitis with or without hepatomegaly is the predominant finding of Chanarin-Dorfman syndrome. Cirrhosis has been reported in patients with long-duration disease. CONCLUSION Local factors or dysfunction of local proteins such as mutations or polymorphisms in hepatic microsomal lipase and arylacetamide deacetylase may contribute the severity of liver involvement, and steatosis may progress to cirrhosis in the early infancy in Chanarin-Dorfman syndrome.
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Affiliation(s)
- M Cakir
- Department of Pediatric Gastroenterology Hepatology and Nutrition, Karadeniz Technical University, Trabzon, Turkey.
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Tannapfel A, Denk H, Dienes HP, Langner C, Schirmacher P, Trauner M, Flott-Rahmel B. [Histopathological diagnosis of non-alcoholic and alcoholic fatty liver disease. Grade 2 consensus-based guidelines]. DER PATHOLOGE 2010; 31 Suppl 2:225-8. [PMID: 20221762 DOI: 10.1007/s00292-010-1298-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Both alcoholic (AFL) and non-alcoholic fatty liver (NAFL) are characterized by lipid deposition in hepatocytes. The diagnosis of steatosis is made when lipid deposition exceeds 5% of hepatocytes, while involvement of more than 50% is called "fatty liver ". An additional inflammatory reaction leads to alcoholic (ASH) or non-alcoholic steatohepatitis (NASH). Steatohepatitis is present when both inflammatory infiltrates of mixed cells in the small liver lobules as well as liver cell injury in terms of ballooning can be detected.Liver biopsy represents the "gold standard" for confirming diagnosis and determining inflammatory activity and potential fibrosis of fatty liver disease.The differential diagnosis of ASH-NASH cannot be made on the basis of histological criteria alone. Steatosis, inflammatory changes and hepatocytic injury can be semiquantified as a "Brunt Score" or "NAS" (NAFLD activity score), providing the basis on which to decide whether or not steatohepatitis is present.People at increased risk of developing a fatty liver possess an increased risk of developing chemotherapy-associated steatohepatitis (CASH).Histologically, pediatric NASH differs from adult NASH and is often only clinically manifest through a mild if persistent elevation in transaminases.
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Affiliation(s)
- A Tannapfel
- Institut für Pathologie, Ruhr-Universität Bochum, Bürkle-de-la-Camp Platz 1, 44789 Bochum.
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Rudolph B, Rivas Y. Nonalcoholic fatty liver disease. Pediatr Rev 2010; 31:e52-3. [PMID: 20595439 DOI: 10.1542/pir.31-7-e52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Risk factors for liver steatosis in obese children and adolescents. Pediatr Neonatol 2010; 51:149-54. [PMID: 20675238 DOI: 10.1016/s1875-9572(10)60028-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 05/05/2009] [Accepted: 05/19/2009] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Concurrent with the recent rise of the incidence in obesity, nonalcoholic fatty liver disease is increasingly prevalent in childhood. The aim of this study was to identify non-invasive biomarkers for liver steatosis in obese children and adolescents. METHODS We used a cross-sectional study to examine risk factors for liver steatosis in obese children and adolescents. Sixty-nine obese subjects aged 6-17 years were recruited. The diagnosis of liver steatosis was made by liver ultrasonography. Anthropometric, serum biochemical variables, and oral glucose tolerance tests were measured. RESULTS Thirty-eight (55.1%) subjects had liver steatosis. Elevated alanine aminotransferase levels (> 30 IU/L in boys and >19 IU/L in girls) were found in 27 (71.1%) of the 38 subjects with liver steatosis. In multivariate logistic regression analysis, liver steatosis was associated with waist circumference and the change of plasma glucose level before and after oral glucose tolerance testing (C-OGTT). For every 5 cm increase in waist circumference, there was an odds ratio of 1.391 for predicting liver steatosis (95% confidence interval: 1.009-1.916, p = 0.044). C-OGTT was the only laboratory variable that independently predicted liver steatosis, with an odds ratio of 1.198 (95% confidence interval: 1.022-1.404, p = 0.026) for each 5 mg/dL of increase. CONCLUSION In this hospital-based sample of obese children and adolescents, liver steatosis was common. Liver steatosis was positively associated waist circumference and C-OGTT. These findings have implications for screening liver steatosis in obese children and adolescents.
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Nonalcoholic fatty liver disease/nonalcoholic steatohepatitis: histological diagnostic criteria and scoring systems. Eur J Gastroenterol Hepatol 2010; 22:643-50. [PMID: 19478676 DOI: 10.1097/meg.0b013e32832ca0cb] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is recognized as the most common cause of chronic liver disease in western countries. NAFLD is etiologically associated with systemic and hepatic insulin resistance and is considered by many as the hepatic manifestation of the metabolic syndrome. NAFLD has a wide histological spectrum ranging from 'simple' steatosis to nonalcoholic steatohepatitis (NASH), which may progress to cirrhosis. Hepatocellular carcinoma may occur in NASH-related cirrhosis. The diagnosis of NAFLD/NASH is based on clinico-pathological criteria. Currently available noninvasive tests for the diagnosis of NASH lack specificity and sensitivity, so liver biopsy, despite its limitations, still remains the 'golden standard' for confirming or excluding NASH in a patient with chronically-elevated liver enzymes and image-detected steatosis. This review examines the currently used criteria for the histopathological diagnosis of NAFLD/NASH in adults and children and the relevant histological scoring systems.
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Tiniakos DG, Vos MB, Brunt EM. Nonalcoholic fatty liver disease: pathology and pathogenesis. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2010; 5:145-71. [PMID: 20078219 DOI: 10.1146/annurev-pathol-121808-102132] [Citation(s) in RCA: 605] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is recognized as the leading cause of chronic liver disease in adults and children. NAFLD encompasses a spectrum of liver injuries ranging from steatosis to steatohepatitis with or without fibrosis. Fibrosis may progress to cirrhosis and complications including hepatocellular carcinoma. Histologic findings represent the complexity of pathophysiology. NAFLD is closely associated with obesity and is most closely linked with insulin resistance; the current Western diet, high in saturated fats and fructose, plays a significant role. There are several mechanisms by which excess triglycerides are acquired and accumulate in hepatocytes. Formation of steatotic droplets may be disordered in NAFLD. Visceral adipose tissue dysfunction in obesity and insulin resistance results in aberrant cytokine expression; many cytokines have a role in liver injury in NAFLD. Cellular stress and immune reactions, as well as the endocannabinoid system, have been implicated in animal models and in some human studies.
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Affiliation(s)
- Dina G Tiniakos
- Laboratory of Histology and Embryology, Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece.
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Histopathologische Diagnose der nichtalkoholischen und alkoholischen Fettlebererkrankung. DER PATHOLOGE 2010; 31:225-37. [DOI: 10.1007/s00292-010-1274-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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De Bruyne RML, Fitzpatrick E, Dhawan A. Fatty liver disease in children: eat now pay later. Hepatol Int 2010; 4:375-85. [PMID: 20305757 DOI: 10.1007/s12072-009-9160-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Revised: 11/26/2009] [Accepted: 12/04/2009] [Indexed: 12/12/2022]
Abstract
INTRODUCTION With the recent epidemic in childhood obesity, nonalcoholic fatty liver disease (NAFLD) has become an emerging problem and a common cause of chronic liver disease in children. METHODS In this review, the most recent insights on the pathogenesis, diagnosis, natural history, and treatment of NAFLD in children are discussed.
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Affiliation(s)
- Ruth M L De Bruyne
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium.
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Yu EL, Schwimmer JB, Lavine JE. Non-alcoholic fatty liver disease: epidemiology, pathophysiology, diagnosis and treatment. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.paed.2009.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Neimark E, LeLeiko NS. Antioxidant effect of bilirubin and pediatric nonalcoholic fatty liver disease. Pediatrics 2009; 124:e1240-1. [PMID: 19948622 DOI: 10.1542/peds.2009-2487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ezequiel Neimark
- Division of Pediatric Gastroenterology, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI 02906, USA
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Hesham A-Kader H. Nonalcoholic fatty liver disease in children living in the obeseogenic society. World J Pediatr 2009; 5:245-54. [PMID: 19911138 DOI: 10.1007/s12519-009-0048-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 06/03/2009] [Indexed: 12/14/2022]
Abstract
BACKGROUND The problem of obesity in children has grown considerably in recent years in the United States as well as the rest of the world. This has resulted in a marked increase in the prevalence of nonalcoholic liver disease in the pediatric age group. Nonalcoholic fatty liver disease (NAFLD) is currently the most common hepatic disorder seen in pediatric hepatology practice. DATA SOURCES We have reviewed the most recent literature regarding the prevalence, pathogenesis as well as the most recent advances in the diagnostic and therapeutic modalities of NAFLD in children. RESULTS NAFLD affects a substantial portion of the population including children. CONCLUSIONS The rising incidence of NAFLD, nonalcoholic steatohepatitis (NASH) and cirrhosis emphasizes the need for effective treatment options. The lack of complete understanding of the pathogenesis of NAFLD still limits our ability to develop novel therapeutic modalities that can target the metabolic derangements implicated in the development of the disorder.
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Affiliation(s)
- H Hesham A-Kader
- Department of Pediatrics, The University of Arizona, Tucson, Arizona, USA.
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de Silva HJ, Dassanayake AS. Non-alcoholic fatty liver disease: confronting the global epidemic requires better awareness. J Gastroenterol Hepatol 2009; 24:1705-7. [PMID: 20136955 DOI: 10.1111/j.1440-1746.2009.06026.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Pardee PE, Lavine JE, Schwimmer JB. Diagnosis and treatment of pediatric nonalcoholic steatohepatitis and the implications for bariatric surgery. Semin Pediatr Surg 2009; 18:144-51. [PMID: 19573756 PMCID: PMC2761012 DOI: 10.1053/j.sempedsurg.2009.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This review focuses on the diagnosis, risk factors, prevalence, pathogenesis and treatment of pediatric nonalcoholic steatohepatitis (NASH). NASH is a progressive form of nonalcoholic fatty liver disease (NAFLD), the most common cause of chronic liver disease in children. The factors that account for differences between children with NASH and children with milder forms of NAFLD are unclear. The diagnosis of NASH requires interpretation of liver histology because no noninvasive markers predict the presence or severity of NASH. There is no proven treatment for NASH. Several clinical trials for NAFLD are in progress; however, clinical trials focusing on NASH are needed. Heightened physician awareness of NAFLD, NASH, and associated risk factors is important to identify and treat affected children.
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Abstract
Alcoholic liver disease and non-alcoholic liver disease share a similar histological spectrum that starts with 'simple' steatosis, and may be accompanied by inflammation. Alcoholic steatohepatitis and non-alcoholic steatohepatitis (NASH) are progressive forms of alcoholic liver disease and non-alcoholic liver disease, respectively, and can evolve into cirrhosis. The currently accepted minimum diagnostic criteria for steatohepatitis include steatosis, lobular inflammation and hepatocellular injury, but not fibrosis. Steatosis involving more than 5% of hepatocytes is required for the diagnosis of non-alcoholic fatty liver disease, but is not necessary for the diagnosis of alcoholic liver disease. Lobular inflammation is usually mild and frequently consists of a mixed, acute and chronic, inflammatory cell infiltrate composed of neutrophils and mononuclear cells. The presence of large numbers of neutrophils favors an alcoholic etiology. Hepatocellular injury in fatty liver disease usually occurs in the form of ballooning, but it can also present as apoptotic (acidophilic) bodies and lytic necrosis. The characteristic pattern of fibrosis in non-cirrhotic steatohepatitis is pericellular/perisinusoidal and is the result of deposition of collagen in the space of Disse. In both alcoholic steatohepatitis and NASH, sinusoidal collagen formation is the result of hepatic stellate cell activation that, in NASH, has been correlated with the grade of steatosis and fibrosis.
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Affiliation(s)
- D G Tiniakos
- Laboratory of Histology & Embryology, Medical School, University of Athens, 75, M. Asias street, Goudi, 11527 Athens, Greece.
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Apoptosis markers in liver biopsy of nonalcoholic steatohepatitis in pediatric patients. Hum Pathol 2008; 39:1816-22. [DOI: 10.1016/j.humpath.2008.04.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 04/08/2008] [Accepted: 04/15/2008] [Indexed: 01/16/2023]
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Yoo J, Lee S, Kim K, Yoo S, Sung E, Yim J. Relationship between insulin resistance and serum alanine aminotransferase as a surrogate of NAFLD (nonalcoholic fatty liver disease) in obese Korean children. Diabetes Res Clin Pract 2008; 81:321-6. [PMID: 18571268 DOI: 10.1016/j.diabres.2008.05.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 04/18/2008] [Accepted: 05/01/2008] [Indexed: 01/05/2023]
Abstract
There has been increasing number of obese children who accompany obesity-related comorbidities. It has been known that nonalcoholic fatty liver disease (NAFLD) as one of obesity-related comorbidities is related with insulin resistance. So, we investigated the relation between insulin resistance and NAFLD, using serum alanine aminotransferase (ALT) as a surrogate of NAFLD among obese children in Korea. The study subjects were 909 obese children aged 9-12 years (boys 613, girls 296). Body mass index (BMI), waist circumference (WC), blood pressure, fasting blood glucose, fasting insulin, lipid profile were measured. ALT, liver enzyme was used as a surrogate of NAFLD and homeostasis model assessment of insulin resistance (HOMA-IR) was used as the index of insulin resistance. The prevalence of elevated serum ALT (>or=40 mg/dl) was 33.4% in boys, and 19.6% in girls respectively. In boys, ALT was correlated with BMI, waist circumference, total cholesterol, triglyceride, HDL-cholesterol, systolic and diastolic blood pressure, HOMA-IR, fasting serum insulin. Odds ratio for HOMA-IR against the elevated ALT (>or=40 mg/dl) was 1.061 (95% confidence interval, 1.020-1.103, P=0.003). In girls, ALT was correlated with BMI, waist circumference, total cholesterol, triglyceride, glucose, systolic and diastolic blood pressure, HOMA-IR, fasting serum insulin. Odds ratio for HOMA-IR against the elevated ALT (>or=40 mg/dl) was 1.042 (95% confidence interval, 0.998-1.088, P=0.063). Among obese Korean children, insulin resistance and ALT, lipid profile, BMI, WC, blood pressure showed significant correlation. Especially, in boys, higher ALT is founded to be independently associated with insulin resistance.
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Affiliation(s)
- JangSuk Yoo
- Department of Family Medicine, Inje University, College of Medicine, Sanggyepaik Hospital, Nowon-Gu, Seoul, Republic of Korea
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Lu JL, Chen JL, Chen MX, Hong J, Chen WX, Zhu JS, Chen NW. Alteration of T helper cells in rats with non-alcoholic fatty liver disease. Shijie Huaren Xiaohua Zazhi 2008; 16:1962-1968. [DOI: 10.11569/wcjd.v16.i18.1962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To detect tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), interleukin-4 (IL-4) and forkhead/winged helix transcription factor p3 (Foxp3) gene expression of fatty liver rats under high fat diet and to explore the role of Th1/Th2 balance and Treg in non-alcoholic fatty liver disease (NAFLD).
METHODS: Sprague-Dawley rats, after one-week normal diet, were randomly divided into two groups: the normal group (treated with normal diet, n = 20) and the high fat diet group (treated with high fat diet, n = 20). The rats were all killed at the eighth and sixteenth week, respectively. TNF-a, IFN-γ, IL-4 and Foxp3 gene expression were detected using real time PCR and pathological changes in liver tissues were recorded.
RESULTS: After high fat diet for 8 weeks, liver became remarkably steatotic, but without significant inflammatory changes. IFN-γ mRNA and IL-4 mRNA had no significant change compared with the normal group, and TNF-α mRNA increased slightly but without statistical significance. The ct value of Foxp3 mRNA was significantly higher than normal (26.12 ± 0.69 vs 24.22 ± 0.62, P < 0.05). After high fat diet for 16 weeks, severe fatty liver, inflammatory cell infiltration and hepatocyte necrosis were observed in high fat diet rats. Both of IFN-γ mRNA and TNF-α mRNA were increased significantly (ct value: 24.52 ± 0.87 vs 29.94 ± 1.44, 24.31 ± 1.13 vs 28.88 ± 1.95, both P < 0.05). IL-4 mRNA was not significantly different from the normal group. Foxp3 mRNA was decreased significantly compared with both normal group and high fat diet group at wk 8 (ct value: 32.57 ± 1.54 vs 24.29 ± 1.08, 26.12 ± 0.69, both P < 0.05).
CONCLUSION: Decreased expression of Foxp3 mRNA and Treg in rat livers may play a key role in development of NAFLD. The combined effect of IFN-γ and TNF-α aggravates liver inflammatory injury.
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Nugent C, Younossi ZM. Evaluation and management of obesity-related nonalcoholic fatty liver disease. ACTA ACUST UNITED AC 2007; 4:432-41. [PMID: 17667992 DOI: 10.1038/ncpgasthep0879] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 05/17/2007] [Indexed: 02/07/2023]
Abstract
The clinicopathologic spectrum of nonalcoholic fatty liver disease (NAFLD) ranges from simple steatosis to nonalcoholic steatohepatitis (NASH). Simple steatosis has a relatively benign clinical course, but NASH can progress to cirrhosis and hepatocellular carcinoma. NAFLD occurs in the absence of significant alcohol use and is considered to be the hepatic manifestation of metabolic syndrome. NAFLD affects approximately 30% of the US population and the incidence seems to be rising as the obesity epidemic continues. At present, the most accurate modality for the diagnosis of NASH is liver biopsy; however, many patients do not have a liver biopsy, and in the absence of more-accurate imaging technologies and serum markers, the diagnosis is frequently one of exclusion. As yet there is no convincingly effective treatment for NAFLD--a multimodal treatment plan that targets obesity, insulin resistance, hyperlipidemia and hypertension might be the best option for these patients.
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