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Syed-Abdul MM. Lipid Metabolism in Metabolic-Associated Steatotic Liver Disease (MASLD). Metabolites 2023; 14:12. [PMID: 38248815 PMCID: PMC10818604 DOI: 10.3390/metabo14010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Metabolic-associated steatotic liver disease (MASLD) is a cluster of pathological conditions primarily developed due to the accumulation of ectopic fat in the hepatocytes. During the severe form of the disease, i.e., metabolic-associated steatohepatitis (MASH), accumulated lipids promote lipotoxicity, resulting in cellular inflammation, oxidative stress, and hepatocellular ballooning. If left untreated, the advanced form of the disease progresses to fibrosis of the tissue, resulting in irreversible hepatic cirrhosis or the development of hepatocellular carcinoma. Although numerous mechanisms have been identified as significant contributors to the development and advancement of MASLD, altered lipid metabolism continues to stand out as a major factor contributing to the disease. This paper briefly discusses the dysregulation in lipid metabolism during various stages of MASLD.
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Affiliation(s)
- Majid Mufaqam Syed-Abdul
- Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON M5G 1L7, Canada
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2
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Jain AK, Buchannan P, Yates KP, Belt P, Schwimmer JB, Rosenthal P, Murray KF, Molleston JP, Scheimann A, Xanthakos SA, Behling CA, Hertel P, Nilson J, Neuschwander-Tetri BA, Tonascia J, Vos MB. Nutrition assessment and MASH severity in children using the Healthy Eating Index. Hepatol Commun 2023; 7:e0320. [PMID: 38055641 PMCID: PMC10984667 DOI: 10.1097/hc9.0000000000000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/19/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Pediatric metabolic-associated fatty liver disease (MAFLD) is a global health problem, with lifestyle modification as its major therapeutic strategy. Rigorous characterization of dietary content on MAFLD in children is lacking. We hypothesized an objectively measured healthier diet would positively modulate MAFLD. METHODS Diet was assessed using the Nutrition Data System for Research in children enrolled from 10 tertiary clinical centers to determine the Healthy Eating Index (HEI, 0-100) and individual food components. RESULTS In all, 119 children were included (13.3 ± 2.7 y), 80 (67%) male, 67 (18%) White, and 90 (76%) Hispanic, with an average body mass index Z-score of 2.2 ± 0.5. Diet was classified as low HEI < 47.94 (n = 39), mid HEI ≥ 47.94 and < 58.89 (n = 41), or high HEI ≥ 58.89 (n=39). Children with high HEI (healthier diet) had lower body weight (p = 0.005) and more favorable lipids. Mean serum triglycerides for low, mid, and high HEI were 163, 148, and 120 mg/dL, respectively; p = 0.04 mid versus high, p = 0.01 low versus high. Mean HDL was 38, 41 and 43 mg/dL; p = 0.02 low vs high. Less severe steatosis was noted with added sugar ≤ 10% of calories (p = 0.03). Higher lobular inflammation is associated with a higher percentage of calories from fat (OR (95% CI) = 0.95 (0.91-1.00), p = 0.04). CONCLUSIONS In children with MAFLD, high HEI is associated with lower body weight and more favorable lipids, while added sugar and fat intake has individual histologic features. Differential consumption of major dietary components may modify both metabolic risk factors and histologic liver injury, highlighting the importance of objective diet assessments in children with MAFLD.
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Affiliation(s)
- Ajay Kumar Jain
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Saint Louis University, St. Louis, Missouri, USA
| | - Paula Buchannan
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Saint Louis University, St. Louis, Missouri, USA
| | - Katherine P. Yates
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Patricia Belt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeffrey B. Schwimmer
- Department of Pediatrics, Division of Gastroenterology, UC San Diego, La Jolla, California, USA
- Department of Gastroenterology, Rady Children’s Hospital, San Diego, California, USA
| | - Philip Rosenthal
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California, San Francisco Benioff Children’s Hospital, San Francisco, California, USA
| | - Karen F. Murray
- Pediatrics Institute, Cleveland Clinic and Cleveland Clinic Children’s Hospital, Cleveland, Ohio
| | - Jean P. Molleston
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Indiana University School of Medicine/Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Ann Scheimann
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stavra A. Xanthakos
- Steatohepatitis Center, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Cynthia A. Behling
- Department of Pediatrics, Division of Gastroenterology, UC San Diego, La Jolla, California, USA
- Department of Gastroenterology and Pacific Rim Pathology, San Diego, California, USA
| | - Paula Hertel
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Jamie Nilson
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Saint Louis University, St. Louis, Missouri, USA
| | | | - James Tonascia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Miriam B. Vos
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
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3
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Paik JM, Henry L, Younossi Y, Ong J, Alqahtani S, Younossi ZM. The burden of nonalcoholic fatty liver disease (NAFLD) is rapidly growing in every region of the world from 1990 to 2019. Hepatol Commun 2023; 7:e0251. [PMID: 37782469 PMCID: PMC10545420 DOI: 10.1097/hc9.0000000000000251] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/09/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND The latest meta-analyses suggest NAFLD is increasing globally. Its limitations may preclude accurate estimates. We evaluated the global NAFLD burden and its' trends in prevalence and NAFLD liver-related mortality (LRM) by sex, age, region, and country over the past 3 decades using data from the Global Burden of Disease (GBD) 2019 study. METHODS Crude and age-standardized NAFLD prevalence and NAFLD-LRM rates were obtained for all-age individuals with NAFLD from 204 countries/territories between 1990 and 2019. Joinpoint trend analysis assessed time trends. Weighted average of the annual percent change (APC) over the period 1990-2019 and 2010-2019 were reported. RESULTS All-age (children and adults) crude global NAFLD prevalence increased:10.5% (561 million)-16.0% (1,236 million); an APC increase: + 1.47% (95% CI, 1.44%, 1.50%). Among adults (+20 y), crude NAFLD prevalence increased (1990: 17.6%, 2019:23.4%; APC: + 1.00%, 95% CI: 0.97%, 1.02%). In all-age groups, the crude NAFLD-LRM rate (per 100,000) increased (1990: 1.75%, 2019: 2.18%; APC: + 0.77% (95% CI, 0.70%, 0.84%). By Joinpoint analysis, from 2010 to 2019, worsening all-age trends in NAFLD prevalence and LRM were observed among 202 and 167 countries, respectively. In 2019, there were 1.24 billion NAFLD prevalent cases and 168,969 associated deaths; Asia regions accounted for 57.2% of all-age prevalent cases and 46.2% of all-age NAFLD-LRM. The highest all-age crude NAFLD prevalence rate was the Middle East and North Africa (LRM 26.5%); the highest all-age crude NAFLD-LRM rate was Central Latin America (5.90 per 100,000). CONCLUSIONS NAFLD is increasing globally in all-age groups-over 80% of countries experienced an increase in NAFLD and NAFLD-LRM. These data have important policy implications for affected countries and for global health.
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Affiliation(s)
- James M. Paik
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Linda Henry
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Center for Outcomes Research in Liver Diseases, Washington DC, USA
| | - Youssef Younossi
- Center for Outcomes Research in Liver Diseases, Washington DC, USA
| | - Janus Ong
- Center for Outcomes Research in Liver Diseases, Washington DC, USA
- University of the Philippines, College of Medicine, Manila, Philippines
| | - Saleh Alqahtani
- Center for Outcomes Research in Liver Diseases, Washington DC, USA
- Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Zobair M. Younossi
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Center for Outcomes Research in Liver Diseases, Washington DC, USA
- The Global NASH Council, Washington DC, USA
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4
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Piester TL, Jagtap N, Kalapala R. Review of paediatric obesity and non-alcoholic fatty liver disease-A focus on emerging non-pharmacologic treatment strategies. Pediatr Obes 2023; 18:e13067. [PMID: 37602954 DOI: 10.1111/ijpo.13067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 08/22/2023]
Abstract
Obesity in paediatrics has become one of the most serious public health concerns worldwide. Paediatric obesity leads to increased adult obesity and is associated with several comorbidities, both physical and psychological. Within gastroenterology, non-alcoholic fatty liver disease (NAFLD) is now the most common cause of paediatric liver disease and the most common cause of liver transplantation in young adults. Treatment for NAFLD largely focuses on treatment of obesity with weight loss strategies. Unfortunately, the traditional method of weight loss using multicomponent lifestyle modification (dietary changes, increased exercise and behavioural modification) has often led to disappointing results. In adult patients with obesity, treatment strategies have evolved to include bariatric surgery and, more recently, bariatric endoscopy. In paediatrics, the obesity and NAFLD epidemics will likely require this variety of treatment to address children in a personalized manner. Here, we present a review of paediatric obesity, paediatric NAFLD and the various treatment strategies to date. We focus on non-pharmacologic and emerging therapies, including bariatric surgery and bariatric endoscopy-based treatments. With such a large population of children and adolescents with obesity, further development of these treatments, including paediatric-focused clinical trials, is essential for these emerging modalities.
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Affiliation(s)
- Travis L Piester
- Department of Pediatrics, Division of Gastroenterology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Nitin Jagtap
- Department of Medical Gastroenterology and Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rakesh Kalapala
- Department of Medical Gastroenterology and Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
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5
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 210] [Impact Index Per Article: 210.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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Abstract
Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in children. Although environmental factors are major contributors to early onset, children have both shared and unique genetic risk alleles as compared with adults with NAFLD. Treatment relies on reducing environmental risk factors, but many children have persistent diseases. No medications are approved specifically for the treatment of NAFLD, but some anti-obesity or diabetes treatments may be beneficial. Pediatric NAFLD increases the risk of diabetes and other cardiovascular risk factors. Long-term prospective studies are needed to determine the long-term risk of hepatic and non-hepatic morbidity and mortality in adulthood.
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Affiliation(s)
- Stavra A Xanthakos
- Professor of Pediatrics, Division of Gastroenterology Hepatology and Nutrition, Cincinnati Children's, Department of Pediatrics, Director, Nonalcoholic Steatohepatitis Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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7
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The Prevalence of Elevated Alanine Aminotransferase Levels Meeting Clinical Action Thresholds in Children with Obesity in Primary Care Practice. J Pediatr 2022; 240:280-283. [PMID: 34562443 PMCID: PMC8841387 DOI: 10.1016/j.jpeds.2021.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023]
Abstract
Using a clinically actionable threshold for alanine aminotransferase to define suspected nonalcoholic fatty liver disease in US children with obesity, the risk of suspected nonalcoholic fatty liver disease was highest for Asian and Hispanic race/ethnicity, male sex, and severe obesity.
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8
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Namwong A, Kumphune S, Seenak P, Chotima R, Nernpermpisooth N, Malakul W. Pineapple fruit improves vascular endothelial dysfunction, hepatic steatosis, and cholesterol metabolism in rats fed a high-cholesterol diet. Food Funct 2022; 13:9988-9998. [DOI: 10.1039/d2fo01199a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hypercholesterolaemia is a significant risk factor for developing vascular disease and fatty liver. Pineapple (Ananas comosus), a tropical fruit widely cultivated in Asia, is reported to exhibit antioxidant and cholesterol-lowering...
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9
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Cohen CC, Li KW, Alazraki AL, Beysen C, Carrier CA, Cleeton RL, Dandan M, Figueroa J, Knight-Scott J, Knott CJ, Newton KP, Nyangau EM, Sirlin CB, Ugalde-Nicalo PA, Welsh JA, Hellerstein MK, Schwimmer JB, Vos MB. Dietary sugar restriction reduces hepatic de novo lipogenesis in adolescent boys with fatty liver disease. J Clin Invest 2021; 131:150996. [PMID: 34907907 PMCID: PMC8670836 DOI: 10.1172/jci150996] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/27/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUNDHepatic de novo lipogenesis (DNL) is elevated in nonalcoholic fatty liver disease (NAFLD). Improvements in hepatic fat by dietary sugar reduction may be mediated by reduced DNL, but data are limited, especially in children. We examined the effects of 8 weeks of dietary sugar restriction on hepatic DNL in adolescents with NAFLD and correlations between DNL and other metabolic outcomes.METHODSAdolescent boys with NAFLD (n = 29) participated in an 8-week, randomized controlled trial comparing a diet low in free sugars versus their usual diet. Hepatic DNL was measured as percentage contribution to plasma triglyceride palmitate using a 7-day metabolic labeling protocol with heavy water. Hepatic fat was measured by magnetic resonance imaging-proton density fat fraction.RESULTSHepatic DNL was significantly decreased in the treatment group (from 34.6% to 24.1%) versus the control group (33.9% to 34.6%) (adjusted week 8 mean difference: -10.6% [95% CI: -19.1%, -2.0%]), which was paralleled by greater decreases in hepatic fat (25.5% to 17.9% vs. 19.5% to 18.8%) and fasting insulin (44.3 to 34.7 vs. 35.5 to 37.0 μIU/mL). Percentage change in DNL during the intervention correlated significantly with changes in free-sugar intake (r = 0.48, P = 0.011), insulin (r = 0.40, P = 0.047), and alanine aminotransferase (ALT) (r = 0.39, P = 0.049), but not hepatic fat (r = 0.13, P = 0.532).CONCLUSIONOur results suggest that dietary sugar restriction reduces hepatic DNL and fasting insulin, in addition to reductions in hepatic fat and ALT, among adolescents with NAFLD. These results are consistent with the hypothesis that hepatic DNL is a critical metabolic abnormality linking dietary sugar and NAFLD.TRIAL REGISTRYClinicalTrials.gov NCT02513121.FUNDINGThe Nutrition Science Initiative (made possible by gifts from the Laura and John Arnold Foundation, Ambrose Monell Foundation, and individual donors), the UCSD Altman Clinical and Translational Research Institute, the NIH, Children's Healthcare of Atlanta and Emory University's Children's Clinical and Translational Discovery Core, Children's Healthcare of Atlanta and Emory University Pediatric Biostatistical Core, the Georgia Clinical and Translational Science Alliance, and the NIH National Institute of Diabetes, Digestive, and Kidney Disease.
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Affiliation(s)
- Catherine C. Cohen
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA.,Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Kelvin W. Li
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, California, USA
| | - Adina L. Alazraki
- Department of Radiology, School of Medicine, Emory University, Atlanta, Georgia, USA.,Department of Radiology, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | - Carissa A. Carrier
- Department of Pediatrics, School of Medicine, UCSD, La Jolla, California, USA
| | - Rebecca L. Cleeton
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Mohamad Dandan
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, California, USA
| | - Janet Figueroa
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jack Knight-Scott
- Department of Radiology, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Cynthia J. Knott
- Altman Clinical and Translational Research Institute, School of Medicine, UCSD, La Jolla, California, USA
| | - Kimberly P. Newton
- Department of Pediatrics, School of Medicine, UCSD, La Jolla, California, USA.,Department of Gastroenterology, Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Edna M. Nyangau
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, California, USA
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology, UCSD, La Jolla, California, USA
| | - Patricia A. Ugalde-Nicalo
- Department of Pediatrics, School of Medicine, UCSD, La Jolla, California, USA.,Department of Gastroenterology, Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Jean A. Welsh
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA.,Department of Gastroenterology, Hepatology, and Nutrition, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Marc K. Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, California, USA
| | - Jeffrey B. Schwimmer
- Department of Pediatrics, School of Medicine, UCSD, La Jolla, California, USA.,Department of Gastroenterology, Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Miriam B. Vos
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA.,Department of Gastroenterology, Hepatology, and Nutrition, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
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10
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Shapiro WL, Noon SL, Schwimmer JB. Recent advances in the epidemiology of nonalcoholic fatty liver disease in children. Pediatr Obes 2021; 16:e12849. [PMID: 34498413 PMCID: PMC8807003 DOI: 10.1111/ijpo.12849] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/24/2021] [Accepted: 08/14/2021] [Indexed: 12/16/2022]
Abstract
Children with obesity are at risk for numerous health problems, including nonalcoholic fatty liver disease (NAFLD). This review focuses on progress made in the epidemiology of NAFLD in children for the years 2015-2020. The estimated prevalence of NAFLD in children with obesity is 26%. The incidence of NAFLD in children has risen rapidly over the past decade. An understanding of the reasons for this rise is incomplete, but over the past 5 years, many studies have provided additional insight into the complexity of risk factors, diagnostic approaches, and associated comorbidities. Risk factors for NAFLD are wide-ranging, including perinatal factors involving both the mother and newborn, as well as environmental toxin exposure. Progress made in the noninvasive assessment will be critical to improving issues related to variability in approach to screening and diagnosis of NAFLD in children. The list of serious comorbidities observed in children with NAFLD continues to grow. Notably, for many of these conditions, such as diabetes and depression, the rates observed have exceeded the rates reported in children with obesity without NAFLD. Recent advancements reviewed show an increased awareness of this problem, while also calling attention to the need for additional research to guide successful efforts at prevention and treatment.
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Affiliation(s)
- Warren L. Shapiro
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California,Department of Gastroenterology, Rady Children’s Hospital, San Diego, California,Southern California Permanente Medical Group, Pasadena, California
| | - Sheila L. Noon
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California
| | - Jeffrey B. Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California,Department of Gastroenterology, Rady Children’s Hospital, San Diego, California
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11
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Chun LF, Yu EL, Sawh MC, Bross C, Nichols J, Polgreen L, Knott C, Schlein A, Sirlin CB, Middleton MS, Kado DM, Schwimmer JB. Hepatic Steatosis is Negatively Associated with Bone Mineral Density in Children. J Pediatr 2021; 233:105-111.e3. [PMID: 33545191 PMCID: PMC8154638 DOI: 10.1016/j.jpeds.2021.01.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/12/2021] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the relationship between hepatic steatosis and bone mineral density (BMD) in children. In addition, to assess 25-hydroxyvitamin D levels in the relationship between hepatic steatosis and BMD. STUDY DESIGN A community-based sample of 235 children was assessed for hepatic steatosis, BMD, and serum 25-hydroxyvitamin D. Hepatic steatosis was measured by liver magnetic resonance imaging proton density fat fraction (MRI-PDFF). BMD was measured by whole-body dual-energy x-ray absorptiometry. RESULTS The mean age of the study population was 12.5 years (SD 2.5 years). Liver MRI-PDFF ranged from 1.1% to 40.1% with a mean of 9.3% (SD 8.5%). Across this broad spectrum of hepatic fat content, there was a significant negative relationship between liver MRI-PDFF and BMD z score (R = -0.421, P < .001). Across the states of sufficiency, insufficiency, and deficiency, there was a significant negative association between 25-hydroxyvitamin D and liver MRI-PDFF (P < .05); however, there was no significant association between vitamin D status and BMD z score (P = .94). Finally, children with clinically low BMD z scores were found to have higher alanine aminotransferase (P < .05) and gamma-glutamyl transferase (P < .05) levels compared with children with normal BMD z scores. CONCLUSIONS Across the full range of liver MRI-PDFF, there was a strong negative relationship between hepatic steatosis and BMD z score. Given the prevalence of nonalcoholic fatty liver disease and the critical importance of childhood bone mineralization in protecting against osteoporosis, clinicians should prioritize supporting bone development in children with nonalcoholic fatty liver disease.
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Affiliation(s)
- Lauren F. Chun
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California
| | - Elizabeth L. Yu
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California,Department of Gastroenterology, Rady Children’s Hospital, San Diego, California
| | - Mary Catherine Sawh
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California,Department of Gastroenterology, Rady Children’s Hospital, San Diego, California
| | - Craig Bross
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California
| | - Jeanne Nichols
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California,Graduate School of Public Health, San Diego State University, San Diego, California
| | - Lynda Polgreen
- Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Cynthia Knott
- Altman Clinical and Translational Research Institute, School of Medicine, University of California San Diego School of Medicine, Ja Jolla, California
| | - Alexandra Schlein
- Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, California
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, California
| | - Michael S. Middleton
- Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, California
| | - Deborah M. Kado
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California,Department of Internal Medicine, University of California San Diego, La Jolla, California
| | - Jeffrey B. Schwimmer
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California,Department of Gastroenterology, Rady Children’s Hospital, San Diego, California
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12
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Yu EL, Schwimmer JB. Epidemiology of Pediatric Nonalcoholic Fatty Liver Disease. Clin Liver Dis (Hoboken) 2021; 17:196-199. [PMID: 33868665 PMCID: PMC8043694 DOI: 10.1002/cld.1027] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/21/2020] [Accepted: 08/02/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Elizabeth L. Yu
- Department of PediatricsDivision of Gastroenterology, Hepatology, and NutritionUniversity of California San Diego School of MedicineLa JollaCA,Department of GastroenterologyRady Children’s HospitalSan DiegoCA
| | - Jeffrey B. Schwimmer
- Department of PediatricsDivision of Gastroenterology, Hepatology, and NutritionUniversity of California San Diego School of MedicineLa JollaCA,Department of GastroenterologyRady Children’s HospitalSan DiegoCA
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13
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Noon SL, D'Annibale DA, Schwimmer MH, Shiels J, Arin J, Durelle J, Newton KP, Goyal NP, Schwimmer JB. Incidence of Depression and Anxiety in a Cohort of Adolescents With Nonalcoholic Fatty Liver Disease. J Pediatr Gastroenterol Nutr 2021; 72:579-583. [PMID: 33346572 PMCID: PMC8815421 DOI: 10.1097/mpg.0000000000003024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine the incidence of clinically diagnosed depression and anxiety in adolescents with nonalcoholic fatty liver disease (NAFLD). METHODS This was a prospective, longitudinal cohort study between January 1, 2012 and July 1, 2018 conducted in a Children's Hospital Pediatric Gastroenterology Clinic. Participants included adolescents 12 to 17 years old at baseline with biopsy-confirmed NAFLD. The primary outcomes were having depression and/or anxiety based upon a clinical diagnosis established by a physician or psychologist. The rates of depression and anxiety were measured at baseline and longitudinally throughout follow-up. RESULTS A total of 160 adolescents with NAFLD were followed for a mean of 3.8 years. At baseline, 8.1% had a diagnosis of depression. During follow-up, an additional 9.5% (95% confidence interval, 4.7-14.3) developed depression. The incidence density of depression was 27 new cases per 1000 person-years at risk. In adolescents with NAFLD, 6.3% had anxiety at baseline and 6.7% (95% confidence interval, 2.6-10.7) developed anxiety during follow-up. The incidence density of anxiety was 18 new cases per 1000 person-years at risk. The change in alanine aminotransferase was significantly worse for adolescents with NAFLD who developed depression compared to those who did not develop depression (P < 0.01). CONCLUSIONS Adolescents with NAFLD had a high incidence of clinically diagnosed depression and anxiety. The rates were higher than expected relative to the available data in the general population. Addressing this mental health burden will require efforts at both the patient level and the systems level.
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Affiliation(s)
- Sheila L Noon
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
- University of California Berkeley, Berkeley, CA
| | - Danielle A D'Annibale
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
- Georgetown University School of Medicine, Washington, DC
| | - Melanie H Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
- Amherst College, Amherst, MA
| | - Jacqueline Shiels
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
- Department of Psychiatry, Kaiser Permanente, Antioch
| | - Jennifer Arin
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
| | - Janis Durelle
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
| | - Kimberly P Newton
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
- Department of Gastroenterology, Rady Children's Hospital, San Diego, CA
| | - Nidhi P Goyal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
- Department of Gastroenterology, Rady Children's Hospital, San Diego, CA
| | - Jeffrey B Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
- Department of Gastroenterology, Rady Children's Hospital, San Diego, CA
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14
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Suri A, Song E, van Nispen J, Voigt M, Armstrong A, Murali V, Jain A. Advances in the Epidemiology, Diagnosis, and Management of Pediatric Fatty Liver Disease. Clin Ther 2021; 43:438-454. [PMID: 33597074 DOI: 10.1016/j.clinthera.2021.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Nonalcoholic fatty liver (NAFL) is a major contributor to pediatric liver disease. This review evaluated the current literature on prevalence, screening, diagnosis, and management of NAFL in children and explored recent advances in the field of pediatric NAFL. METHODS A PubMed search was performed for manuscripts describing disease burden, diagnosis, and management strategies in pediatric NAFL published within the past 15 years. Systematic reviews, clinical practice guidelines, randomized controlled trials, and cohort and case-control studies were reviewed for the purpose of this article. FINDINGS The prevalence of NAFL in children is increasing. It is a leading cause of liver-related morbidity and mortality in children. Screening and diagnosis of NAFL in children are a challenge. Lifestyle changes and exercise are the cornerstones of the management of NAFL. IMPLICATIONS Further research is needed to develop better screening and diagnostic tools for pediatric NAFL, including noninvasive diagnostics. NAFL therapeutics is another area of much-needed, ongoing research.
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Affiliation(s)
- Anandini Suri
- Department of Pediatrics, School of Medicine, St. Louis University, St. Louis, Missouri, USA.
| | - Eric Song
- Department of Pediatrics, School of Medicine, St. Louis University, St. Louis, Missouri, USA
| | - Johan van Nispen
- Department of Pediatrics, School of Medicine, St. Louis University, St. Louis, Missouri, USA
| | - Marcus Voigt
- Department of Pediatrics, School of Medicine, St. Louis University, St. Louis, Missouri, USA
| | - Austin Armstrong
- Department of Pediatrics, School of Medicine, St. Louis University, St. Louis, Missouri, USA
| | - Vidul Murali
- Department of Pediatrics, School of Medicine, St. Louis University, St. Louis, Missouri, USA
| | - Ajay Jain
- Department of Pediatrics, School of Medicine, St. Louis University, St. Louis, Missouri, USA
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15
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Sahota AK, Shapiro WL, Newton KP, Kim ST, Chung J, Schwimmer JB. Incidence of Nonalcoholic Fatty Liver Disease in Children: 2009-2018. Pediatrics 2020; 146:peds.2020-0771. [PMID: 33214329 PMCID: PMC7706110 DOI: 10.1542/peds.2020-0771] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In 2007, the American Academy of Pediatrics recommended that children with obesity should be screened for nonalcoholic fatty liver disease (NAFLD). Population epidemiology reveals that NAFLD is common in children; however, little is known about rates of clinical diagnosis. In this study, we aim to determine screening practices, annual incidence, and clinical characteristics of NAFLD in children within an integrated community health system. METHODS Using electronic health records, we identified patients newly diagnosed (aged 5-18) with NAFLD on the basis of diagnostic codes from the 9th and 10th revisions of the International Classification of Diseases. We calculated screening rates and annual incidence rates of NAFLD from January 1, 2009, to December 31, 2018. RESULTS In this study, we evaluated 7 884 844 patient-years. Screening was performed in 54.0% of children with obesity and 24.0% of children with overweight. The results revealed 36 658 children aged 9 to 18 with overweight or obesity and alanine aminotransferase >30 U/L. Of these children, 12.3% received further workup for NAFLD. The incidence of an NAFLD diagnosis significantly increased over time, with 36.0 per 100 000 in 2009 and 58.2 per 100 000 in 2018 (P < .0001). CONCLUSIONS Our study of a large integrated health care system in southern California revealed that the incidence of NAFLD in children is increasing, although many children may remain undiagnosed.
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Affiliation(s)
- Amandeep K. Sahota
- Southern California Permanente Medical Group, Pasadena, California;,Contributed equally as co-first authors
| | - Warren L. Shapiro
- Southern California Permanente Medical Group, Pasadena, California;,Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, School of Medicine, University of California, San Diego, La Jolla, California; and,Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Rady Children’s Hospital, San Diego, California,Contributed equally as co-first authors
| | - Kimberly P. Newton
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, School of Medicine, University of California, San Diego, La Jolla, California; and,Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Rady Children’s Hospital, San Diego, California
| | - Steven T. Kim
- Southern California Permanente Medical Group, Pasadena, California
| | - Joanie Chung
- Southern California Permanente Medical Group, Pasadena, California
| | - Jeffrey B. Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, School of Medicine, University of California, San Diego, La Jolla, California; and,Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Rady Children’s Hospital, San Diego, California
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16
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Goldner D, Lavine JE. Nonalcoholic Fatty Liver Disease in Children: Unique Considerations and Challenges. Gastroenterology 2020; 158:1967-1983.e1. [PMID: 32201176 DOI: 10.1053/j.gastro.2020.01.048] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/30/2019] [Accepted: 01/05/2020] [Indexed: 02/06/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is increasing in prevalence in concert with the global epidemic of obesity and is being diagnosed at increasingly younger ages. The unique histologic features and early presentation of disease in pediatrics suggest that children and adults may differ with regard to etiopathogenesis, with children displaying a greater vulnerability to genetic and environmental factors. Of significant relevance to pediatrics, in utero and perinatal stressors may alter the lifelong health trajectory of a child, increasing the risk of NAFLD and other cardiometabolic diseases. The development and progression of disease in childhood is likely to carry increased risk of long-term morbidity. Novel biomarkers and therapeutic agents are needed to avoid the otherwise inevitable health and societal consequences of this rapidly expanding pediatric population.
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Affiliation(s)
- Dana Goldner
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Medical Center, New York, New York
| | - Joel E Lavine
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Medical Center, New York, New York.
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17
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Goyal NP, Sawh MC, Ugalde-Nicalo P, Angeles JE, Proudfoot JA, Newton KP, Middleton MS, Sirlin CB, Schwimmer JB. Evaluation of Quantitative Imaging Biomarkers for Early-phase Clinical Trials of Steatohepatitis in Adolescents. J Pediatr Gastroenterol Nutr 2020; 70:99-105. [PMID: 31633654 PMCID: PMC8053386 DOI: 10.1097/mpg.0000000000002535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Early-phase pediatric nonalcoholic fatty liver disease (NAFLD) clinical trials are designed with noninvasive parameters to assess potential efficacy. Increasingly, these parameters include magnetic resonance imaging (MRI)-derived proton density fat fraction (PDFF) and MR elastography (MRE)-derived shear stiffness as biomarkers of hepatic steatosis and fibrosis, respectively. Understanding fluctuations in these measures is essential for calculating trial sample sizes, interpreting results, and planning clinical drug trials in children with NAFLD. Lack of such data in children constitutes a critical knowledge gap. Therefore, the primary aim of this study was to assess whole-liver MRI-PDFF change in adolescents with nonalcoholic steatohepatitis (NASH) over 12 weeks. METHODS Adolescents 12 to 19 years with biopsy-proven NASH undergoing standard-of-care treatment were enrolled. Baseline and week-12 assessments of anthropometrics, transaminases, MRI-PDFF, and MRE stiffness were obtained. RESULTS Fifteen adolescents were included (mean age 15.7 [SD 2.9] years). Hepatic MRI-PDFF was stable over 12 weeks (mean absolute change -0.8%, P = 0.24). Correlation between baseline and week-12 values of MRI-PDFF was high (ICC = 0.97, 95% CI 0.90-0.99). MRE stiffness was stable (mean percentage change 2.7%, P = 0.44); correlation between baseline and week-12 values was moderate (ICC = 0.47; 95% CI 0-0.79). Changes in weight, BMI, and aminotransferases were not statistically significant. CONCLUSION In adolescents with NASH, fluctuations in hepatic MRI-PDFF and MRE stiffness over 12 weeks of standard-of-care were small. These data on the natural fluctuations in quantitative imaging biomarkers can serve as a reference for interventional trials in pediatric NASH and inform the interpretation and planning of clinical trials.
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Affiliation(s)
- Nidhi P. Goyal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego School of Medicine, San Diego, California
- Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego, California
| | - Mary Catherine Sawh
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego School of Medicine, San Diego, California
- Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego, California
| | - Patricia Ugalde-Nicalo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego School of Medicine, San Diego, California
| | - Jorge E. Angeles
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego School of Medicine, San Diego, California
| | - James A. Proudfoot
- Clinical and Translational Research Institute, University of California, San Diego
| | - Kimberly P. Newton
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego School of Medicine, San Diego, California
- Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego, California
| | - Michael S. Middleton
- Liver Imaging Group, Department of Radiology, University of California, San Diego School of Medicine, San Diego, California
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology, University of California, San Diego School of Medicine, San Diego, California
| | - Jeffrey B. Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego School of Medicine, San Diego, California
- Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego, California
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18
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Wang CW, Chuang HY, Liao KW, Yu ML, Dai CY, Chang WT, Tsai CH, Chiang HC, Huang PC. Urinary thiodiglycolic acid is associated with increased risk of non-alcoholic fatty liver disease in children living near a petrochemical complex. ENVIRONMENT INTERNATIONAL 2019; 131:104978. [PMID: 31325714 DOI: 10.1016/j.envint.2019.104978] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/27/2019] [Accepted: 06/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Occupational and experimental studies have revealed that high vinyl chloride monomer (VCM) exposure is associated with non-alcoholic fatty liver disease (NAFLD). Epidemiological study reported that children living near a petrochemical complex have elevated exposure levels of urinary thiodiglycolic acid (TDGA), a potential VCM biomarker. However, no studies on the association of urinary TDGA exposure with NAFLD in children are available. AIM To assess the association of pediatric NAFLD with urinary TDGA exposure in school-aged children living near a petrochemical complex. MATERIALS AND METHODS In total, 261 school-aged children (aged 6-13 years) living near a petrochemical complex were recruited during October 2013 to September 2014. First morning spot urine was sampled for analyzing urinary TDGA through liquid chromatography-tandem mass spectrometry. Ultrasonography and serum alanine aminotransferase (ALT) were examined in each participant. NAFLD was diagnosed as recommended by the North American and European Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN and ESPGHAN). Risk for NAFLD with urinary TDGA exposure in children was evaluated using a multivariate logistic regression model. RESULTS The percentage of children with NAFLDNASPGHAN and NAFLDESPGHAN were 9.6% and 11.5%, respectively. Median levels (μg/g creatinine) of urinary TDGA of children with NAFLDNASPGHAN (vs non-NAFLDNASPGHAN) and NAFLDESPGHAN (vs non-NAFLDESPGHAN) were 118.0 (vs 96.6) and 113.1 (vs 96.5), respectively. Participants in the highest urinary TDGA quartile (Q4: ≥160.0 μg/g creatinine) had a significantly increased risk (odds ratio [OR] = 4.95; 95% confidence interval [CI] = 1.15-21.38; P = 0.032) and dose-response trend (Ptrend = 0.045) for NAFLDNASPGHAN compared with those in the lowest urinary TDGA quartile (Q1: <35.4 μg/g creatinine) after adjustment for age, gender, BMI, triglycerides, HOMA-IR and distance of elementary schools from the petrochemical complex. Participants in the Q4 had borderline significantly increased risk (OR = 3.45; 95% CI = 0.89-13.42; P = 0.074) correlated with NAFLDESPGHAN compared with those in the Q1 after adjustment for confounders. CONCLUSION Our findings support the hypothesis that children exposed to higher urinary TDGA levels significantly increased pediatric NAFLD risk. Serum ALT levels can be a useful predictor for screening children's NAFLD in field studies. Large and longitudinal studies are warranted to elucidate the association.
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Affiliation(s)
- Chih-Wen Wang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Taiwan
| | - Hung-Yi Chuang
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kai-Wei Liao
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wan-Ting Chang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Cheng-Hsan Tsai
- Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Hung-Che Chiang
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Po-Chin Huang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Safety, Health and Environmental Engineering, National United University, Miaoli, Taiwan.
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19
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Mouzaki M, Shah A, Arce-Clachar AC, Hardy J, Bramlage K, Xanthakos SA. Extremely low levels of low-density lipoprotein potentially suggestive of familial hypobetalipoproteinemia: A separate phenotype of NAFLD? J Clin Lipidol 2019; 13:425-431. [DOI: 10.1016/j.jacl.2019.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/23/2019] [Accepted: 02/07/2019] [Indexed: 12/25/2022]
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20
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Chen YS, Liu HM, Lee TY. Ursodeoxycholic Acid Regulates Hepatic Energy Homeostasis and White Adipose Tissue Macrophages Polarization in Leptin-Deficiency Obese Mice. Cells 2019; 8:cells8030253. [PMID: 30884843 PMCID: PMC6468643 DOI: 10.3390/cells8030253] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 12/15/2022] Open
Abstract
Obesity has been shown to play a role in the pathogenesis of several forms of metabolic syndrome, including non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes. Ursodeoxycholic acid (UDCA) has been shown to possess antioxidant and anti-inflammatory properties and prevents mitochondrial dysfunction in the progression of obesity-associated diseases. The aim of the study was to evaluate the mechanisms of UDCA during obesity-linked hepatic mitochondrial dysfunction and obesity-associated adipose tissue macrophage-induced inflammation in obese mice. UDCA significantly decreased lipid droplets, reduced free fatty acids (FFA) and triglycerides (TG), improved mitochondrial function, and enhanced white adipose tissue browning in ob/ob mice. This is associated with increased hepatic energy expenditure, mitochondria biogenesis, and incorporation of bile acid metabolism (Abca1, Abcg1 mRNA and BSEP, FGFR4, and TGR5 protein). In addition, UDCA downregulated NF-κB and STAT3 phosphorylation by negative regulation of the expression of SOCS1 and SOCS3 signaling. These changes were accompanied by decreased angiogenesis, as shown by the downregulation of VEGF, VCAM, and TGF-βRII expression. Importantly, UDCA is equally effective in reducing whole body adiposity. This is associated with decreased adipose tissue expression of macrophage infiltration (CD11b, CD163, and CD206) and lipogenic capacity markers (lipofuscin, SREBP-1, and CD36). Furthermore, UDCA significantly upregulated adipose browning in association with upregulation of SIRT-1-PGC1-α signaling in epididymis adipose tissue (EWAT). These results suggest that multi-targeted therapies modulate glucose and lipid biosynthesis fluxes, inflammatory response, angiogenesis, and macrophage differentiation. Therefore, it may be suggested that UDCA treatment may be a novel therapeutic agent for obesity.
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Affiliation(s)
- Yu-Sheng Chen
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, No. 259, Wen-Hwa 1st Road, Kwei-Shan, Taoyuan 333, Taiwan.
- Division of Chinese Acupuncture, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, No. 123, Dinghu Road, Guishan District, Taoyuan 333, Taiwan.
| | - Hsuan-Miao Liu
- Graduate Institute of Traditional Chinese Medicine, School of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Tzung-Yan Lee
- Graduate Institute of Traditional Chinese Medicine, School of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung 204, Taiwan.
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21
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Jain A. Pediatric Fatty Liver Disease. MISSOURI MEDICINE 2019; 116:123-128. [PMID: 31040498 PMCID: PMC6461321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Ajay Jain
- Ajay Jain, MD, is in the Department of Pediatrics, Saint Louis University, St. Louis, Missouri
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22
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McCommis KS, Finck BN. Treating Hepatic Steatosis and Fibrosis by Modulating Mitochondrial Pyruvate Metabolism. Cell Mol Gastroenterol Hepatol 2018; 7:275-284. [PMID: 30686780 PMCID: PMC6352854 DOI: 10.1016/j.jcmgh.2018.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/20/2018] [Accepted: 09/24/2018] [Indexed: 12/12/2022]
Abstract
A hepatic comorbidity of metabolic syndrome, known as nonalcoholic fatty liver disease (NAFLD), is increasing in prevalence in conjunction with the pandemics of obesity and diabetes. The spectrum of NAFLD ranges from simple hepatic fat accumulation to a more severe disease termed nonalcoholic steatohepatitis (NASH), involving inflammation, hepatocyte death, and fibrosis. Importantly, NASH is linked to a much higher risk of cirrhosis, liver failure, and hepatocellular carcinoma, as well as an increased risk for nonhepatic malignancies and cardiovascular disease. Interest in the understanding of the disease processes and search for treatments for the spectrum of NAFLD-NASH has increased exponentially, but there are no approved pharmacologic therapies. In this review, we discuss the existing literature supporting insulin-sensitizing thiazolidinedione compounds as potential drug candidates for the treatment of NASH. In addition, we put these results into new context by summarizing recent studies suggesting these compounds alter mitochondrial metabolism by binding and inhibiting the mitochondrial pyruvate carrier.
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Affiliation(s)
| | - Brian N. Finck
- Correspondence Address correspondence to: Brian N. Finck, 660 South Euclid Avenue, Campus Box 8031, St. Louis, Missouri 63110. fax: (314) 362-8230.
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