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Ko HJ, Woo S, Han J, Kim YM, Lim HJ, Kim MJ, Park YS, Park KH. Which obesity index is the most useful marker for predicting hepatic steatosis in children and adolescents with obesity? A cross-sectional study using quantitative magnetic resonance imaging. Obes Res Clin Pract 2023; 17:335-342. [PMID: 37336708 DOI: 10.1016/j.orcp.2023.05.013] [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: 01/05/2023] [Revised: 04/11/2023] [Accepted: 05/21/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION We aimed to evaluate the relationships between hepatic steatosis and various indices of obesity, and to identify the most useful index for the prediction of hepatic steatosis in children and adolescents with obesity. METHODS A total of 226 children and adolescents with a mean body mass index (BMI) z-score of 2.65 and a mean age of 11.4 years were subjected to anthropometric and body composition measurements, laboratory testing, abdominal fat mass assessment, and hepatic fat accumulation by magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF). The participants were divided into quartiles according to the severity of their hepatic steatosis, and the presence of hepatic steatosis was defined using an MRI-PDFF ≥ 5%. RESULTS The multivariate ordinal regression analysis showed that the severity of hepatic steatosis was positively associated with BMI, waist circumference, waist-to-hip ratio, waist-to-height ratio, fat mass, fat-free mass, visceral adiposity, and abdominal subcutaneous adiposity. Higher activities of liver enzymes and higher concentrations of triglyceride, C-reactive protein, fasting insulin, and leptin were associated with more severe hepatic steatosis, whereas high-density lipoprotein-cholesterol and adiponectin were negatively associated with hepatic steatosis. The indices of obesity with areas under the receiver operating characteristic curves (AUCs) > 0.8 for the prediction of hepatic steatosis were liver enzymes, visceral adipose tissue area, waist-to-hip ratio, and waist-to-height ratio. CONCLUSION The severity of hepatic steatosis significantly correlated with various indices of obesity and cardiometabolic markers in children and adolescents with obesity. The indices of abdominal obesity would be the most useful for the prediction of hepatic steatosis.
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Affiliation(s)
- Hae-Jin Ko
- Department of Family Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Sarah Woo
- Department of Medical Sciences, College of Medicine, Hallym University, Chuncheon-si 24252, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon-si 24252, Republic of Korea
| | - Yoon Myung Kim
- University College, Yonsei University International Campus, Incheon 21983, Republic of Korea
| | - Hyun Jung Lim
- Department of Medical Nutrition, Kyung Hee University, Yongin-si 17104, Republic of Korea
| | - Min-Jeong Kim
- Department of Radiology, Hallym University Medical Center, Hallym University College of Medicine, Anyang-si 14068, Republic of Korea
| | - Yong Soon Park
- Department of Family Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si 24253, Republic of Korea
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si 14068, Republic of Korea.
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Riekki H, Aitokari L, Kivelä L, Lahti S, Hiltunen P, Vuorela N, Huhtala H, Lakka TA, Kurppa K. Prevalence and associated factors of metabolic-associated fatty liver disease in overweight Finnish children and adolescents. Front Endocrinol (Lausanne) 2023; 14:1090344. [PMID: 37409224 PMCID: PMC10319394 DOI: 10.3389/fendo.2023.1090344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 04/04/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Data on the prevalence of pediatric fatty liver disease remain limited, partly due to challenges in diagnosis. A novel concept of metabolic-associated fatty liver disease (MAFLD) makes it possible to establish the diagnosis in overweight children with sufficiently elevated alanine aminotransferase (ALT). We investigated the prevalence, risk factors, and metabolic co-morbidities of MAFLD in a large group of overweight children. Methods Data on 703 patients aged 2-16 years examined due to overweight in different levels of healthcare in 2002-2020 were collected retrospectively from patient records. MAFLD was here defined as ALT >2x reference (>44 U/l in girls and >50 U/l in boys) in overweight children according to recently updated definition. Patients with MAFLD and without it were compared, and subgroup analyses were conducted among boys and girls. Results Median age was 11.5 years, and 43% were girls. Altogether 11% were overweight, 42% obese and 47% severely obese. Abnormal glucose metabolism was present in 44%, dyslipidemia in 51%, hypertension in 48% and type 2 diabetes (T2D) in 2%. MAFLD prevalence varied between 14-20% in examined years without significant change (p=0.878). The pooled prevalence over the years was 15% (boys 18%, girls 11%; p=0.018), peaking in girls at early puberty and increasing in boys with age and puberty. Associated factors in boys were T2D (OR 7.55, 95% CI 1.23-46.2), postpubertal stage (5.39, 2.26-12.8), increased fasting insulin (3.20, 1.44-7.10), hypertriglyceridemia (2.97, 1.67-5.30), hyperglycemia (2.88, 1.64-5.07), decreased high-density lipoprotein (HDL) cholesterol (2.16, 1.18-3.99), older age (1.28, 1.15-1.42) and higher body-mass-index (1.01, 1.05-1.15), and in girls T2D (18.1, 3.16-103), hypertriglyceridemia (4.28, 1.99-9.21), and decreased HDL (4.06, 1.87-8.79). Conclusion Prevalence of MAFLD was 15%, with no statistically significant increase in the 2000s. The condition was associated in general with male gender, puberty stage and disturbances in glucose and lipid metabolism, and higher age and BMI in boys.
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Affiliation(s)
- Hanna Riekki
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Linnea Aitokari
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
- Celiac Disease Research Center, Tampere University, Tampere, Finland
| | - Laura Kivelä
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
- Celiac Disease Research Center, Tampere University, Tampere, Finland
- Children’s Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Siiri Lahti
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Pauliina Hiltunen
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Nina Vuorela
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Timo A. Lakka
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Kalle Kurppa
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
- Celiac Disease Research Center, Tampere University, Tampere, Finland
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- University Consortium of Seinäjoki, Seinäjoki, Finland
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Zambrano Bermeo RN, Estrada Gonzalez C, Guerra EDPH. Influence of Personal Factors on Health-Promoting Behavior in College Students: A Structural Equation Modeling Approach. J Multidiscip Healthc 2023; 16:1259-1270. [PMID: 37179974 PMCID: PMC10167957 DOI: 10.2147/jmdh.s401870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/14/2023] [Indexed: 05/15/2023] Open
Abstract
Purpose This study aimed to determine how personal factors influence health-promoting behavior in university students using a structural equation modeling approach guided by the Health Promotion Model. Patients and Methods An analytical cross-sectional study was conducted. The study included 763 health science students from four universities in Cali, Colombia, who answered a questionnaire on personal factors and Health Promoting Lifestyle Profile II, Spanish version, which was validated in the study population. The direct and indirect relationships between personal factors and health-promoting behaviors were assessed using structural equation modeling. Data analysis was performed using descriptive statistics and structural equation modeling. Results A significant relationship was noted between the biological and psychological personal factors of the measurement model (p < 0.05). Psychological personal factors (self-esteem and perceived health status) positively influence health promoting behavior in university students (Hypothesis 2). It's not possible to demonstrate that health promoting behavior is positively influenced by personal biological factors (Hypothesis 1) and by personal sociocultural factors (Hypothesis 3). Conclusion There is a need for interventions that help improve the health-promoting lifestyle profile and are focused on enhancing the self-esteem and perceived health status of university students.
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Malki GJ, Goyal NP, Ugalde-Nicalo P, Chun LF, Zhang J, Ding Z, Wei Y, Knott C, Batakis D, Henderson W, Sirlin CB, Middleton MS, Schwimmer JB. Association of Hepatic Steatosis with Adipose and Muscle Mass and Distribution in Children. Metab Syndr Relat Disord 2023; 21:222-230. [PMID: 37083405 PMCID: PMC10181799 DOI: 10.1089/met.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Background: Pediatric studies have shown associations between hepatic steatosis and total body fat, visceral fat, and lean mass. However, these associations have not been assessed simultaneously, leaving their relative importance unknown. Objective: To evaluate associations between hepatic steatosis and total-body adiposity, visceral adiposity, and lean mass in children. Method: In children at risk for fatty liver, hepatic steatosis, adipose, and lean mass were estimated with magnetic resonance imaging and dual-energy X-ray absorptiometry. Results: Two hundred twenty-seven children with mean age 12.1 years had mean percent body fat of 38.9% and mean liver fat of 8.4%. Liver fat was positively associated with total-body adiposity, visceral adiposity, and lean mass (P < 0.001), and negatively associated with lean mass percentage (P < 0.001). After weight adjustment, liver fat was only positively associated with measures of central adiposity (P < 0.001). Visceral adiposity also had the strongest association with liver fat (P < 0.001). Conclusions: In children, hepatic steatosis is more strongly associated with visceral adiposity than total adiposity, and the association of lean mass is not independent of weight or fat mass. These relationships may help guide the choice of future interventions to target hepatic steatosis.
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Affiliation(s)
- Ghattas J Malki
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Nidhi P Goyal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California, USA
- Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | | | - Lauren F Chun
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Jasen Zhang
- Division of Biostatistics and Bioinformatics, University of California San Diego Herbert Wertheim School of Public Health and Human Longevity Science, San Diego, California, USA
| | - Ziyi Ding
- Division of Biostatistics and Bioinformatics, University of California San Diego Herbert Wertheim School of Public Health and Human Longevity Science, San Diego, California, USA
| | - Yingjia Wei
- Division of Biostatistics and Bioinformatics, University of California San Diego Herbert Wertheim School of Public Health and Human Longevity Science, San Diego, California, USA
| | - Cynthia Knott
- Altman Clinical and Translational Research Institute, School of Medicine, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Danielle Batakis
- Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Walter Henderson
- Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Michael S Middleton
- Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Jeffrey B Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California, USA
- Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
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5
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Liu L, Tan R, Fang Z, Li L, Chen X, Luo Y, Yang D. Prevalence of non-alcoholic fatty liver disease in pediatric mental disorder inpatients: a tertiary mental health referral hospital study. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:64-69. [PMID: 36281916 DOI: 10.17235/reed.2022.8986/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND AIM Studies have revealed a high prevalence of non-alcoholic fatty liver disease (NAFLD) among adult patients with mental disorders, as well as its associate risk factors, however little is known about these in pediatric population. The aim of the present study is to investigate the prevalence of NAFLD in pediatric inpatients with mental disorder, as well as to explore the risk factors. METHODS In this retrospective study, we included 1156 pediatric inpatients with mental disorder admitted to our hospital between January 2020 and December 2021, including inpatients with schizophrenia, bipolar disorder, depressive disorder and other mental disorders. Relevant clinical data were obtained from the electronic medical records. We calculated the prevalence rate of NAFLD, and compared NAFLD prevalence between gender, mental disorders types, antipsychotics use, and comorbidities. Multivariable logistic regression was used to examine risk factors associated with NAFLD. RESULTS The prevalence of NAFLD in pediatric inpatients with mental disorders was 7.35% (85/1156). Patients with NAFLD had senior age than those without NAFLD (15.33±1.75 vs 14.21±1.95 year-old, P<0.001). The NAFLD prevalence in participants with schizophrenia (12.11%) was higher than in participants with bipolar disorder (8.45%), depressive disorder (7.06%) and other mental disorders (2.97%)(p=0.002). The NAFLD prevalence was higher in participants who used antipsychotics (8.70%) than those who didn't (5.45%) (p=0.038). Multivariate analysis revealed that senior age, body weight (overweight/obese) and dyslipidemia were independent risk factors for NAFLD in pediatric inpatients with mental disorders. CONCLUSIONS The NAFLD prevalence was is higher in those patients with schizophrenia and receiving antipsychotic medication. Metabolic factors and longer evolution may explain these differences.
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Affiliation(s)
- Lini Liu
- Psychiatry, The Second People's Hospital of Hunan Province, China
| | - Rongrong Tan
- Psychiatry, The Second People's Hospital of Hunan Province
| | - Zhenghua Fang
- Psychiatry, The Second People's Hospital of Hunan Province
| | - Li Li
- Psychiatry, The Second People's Hospital of Hunan Province
| | - Xi Chen
- Psychiatry, The Second People's Hospital of Hunan Province
| | - Yinli Luo
- Psychiatry, The Second People's Hospital of Hunan Province
| | - Dong Yang
- Psychiatry, The Second People's Hospital of Hunan Province
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Hegarty R, Kyrana E, Fitzpatrick E, Dhawan A. Fatty liver disease in children (MAFLD/PeFLD Type 2): unique classification considerations and challenges. Ther Adv Endocrinol Metab 2023; 14:20420188231160388. [PMID: 36968656 PMCID: PMC10034351 DOI: 10.1177/20420188231160388] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/11/2023] [Indexed: 03/24/2023] Open
Abstract
In children, fatty liver disease is a group of disorders that often overlaps with inherited metabolic disorders (IMDs), which requires prompt diagnosis and specific management. Metabolic dysfunction-associated fatty liver disease (MAFLD) or, formerly, non-alcoholic fatty liver disease (NAFLD) is the hepatic component of a multisystemic disease that requires a positive criteria in metabolic dysfunction for diagnosis. However, in children, the diagnosis of MAFLD is one of the exclusions of an IMD [paediatric fatty liver disease (PeFLD) type 1] including the possibility that an IMD can be identified in the future following investigations that may be negative at the time. Therefore, while children with fatty liver with metabolic dysfunction could be classified as MAFLD (PeFLD type 2) and managed that way, those who do not fulfil the criteria for metabolic dysfunction should be considered separately bearing in mind the possibility of identifying a yet undiagnosed IMD (PeFLD type 3). This concept is ever more important in a world where MAFLD is the most common cause of liver disease in children and adolescents in whom about 7% are affected. The disease is only partially understood, and awareness is still lacking outside hepatology and gastroenterology. Despite its increasing pervasiveness, the management is far from a one-size-fits-all. Increasing complexities around the genetic, epigenetic, non-invasive modalities of assessment, psychosocial impacts, therapeutics, and natural history of the disease have meant that an individualised approach is required. This is where the challenge lies so that children with fatty liver are considered on their own merits. The purpose of this review is to give a clinical perspective of fatty liver disease in children with relevance to metabolic dysfunction.
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Affiliation(s)
- Robert Hegarty
- Paediatric Liver, GI and Nutrition Centre, and
MowatLabs, King’s College Hospital, London, UK
| | - Eirini Kyrana
- Paediatric Liver, GI and Nutrition Centre, and
MowatLabs, King’s College Hospital, London, UK
| | - Emer Fitzpatrick
- Department of Gastroenterology, Hepatology and
Nutrition, Our Lady’s Hospital Crumlin, Dublin, Ireland
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Hickcox L, Bates S, Movahed MR. Presence of physical symptoms in healthy adolescence found to be associated with female gender, obesity, tachycardia, diastolic hypertension and smoking. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2022; 12:315-319. [PMID: 36743511 PMCID: PMC9890197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The goal of this study was to evaluate any association between physical symptoms and abnormal clinical history in adolescence undergoing screening echocardiography performed by Anthony Bates Foundation. METHOD The Anthony Bates Foundation has been performing screening echocardiography across the United States for the prevention of sudden death since 2001. We performed uni- and multivariate analysis to evaluate any association between physical symptoms with gender, smoking, obesity, heart rate, and hypertension. RESULTS We found a strong association between symptoms and the female gender (33% vs. 17.5% of males, P < 0.001). Furthermore, obesity (46.5% vs. 22.5%, P < 0.001), smoking (46.2% vs. 22.5%, P = 0.04), heart rate > 90 (34.8 vs. 22.8%, P = 0.001), and diastolic blood pressure > 90 (34.9% vs. 23.4%, P = 0.03) were all associated with symptoms. Increased systolic pressure was not associated with physical symptoms (24.3% vs. 21.9%, P = 0.4). Using multivariate analysis, female gender, diastolic blood pressure and obesity remained independently associated with physical symptoms. (Female gender: OR: 2.2, CI: 1.7-2.9, P < 0.001, obesity: OR: 2.5, CI 1.2-5.05, P = 0.009, and high diastolic blood pressure: OR: 2.08, CI 1.1-3.7, P = 0.01). CONCLUSION Physical symptoms are associated with smoking, female gender, obesity, tachycardia, and high diastolic blood pressure but not systolic pressure in adolescence undergoing routine screening echocardiography.
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Affiliation(s)
| | | | - Mohammad Reza Movahed
- University of Arizona Sarver Heart CenterTucson, Arizona, USA,University of ArizonaPhoenix, USA
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Ley SL, Kidwell KM, Van Dyk TR, Orkin S, Odar Stough C, Howarth T, Goetz AR, Xanthakos SA, Bramlage K, Mouzaki M, Arce-Clachar AC, Zeller MH. Insight Into the Adolescent Patient Experience With Nonalcoholic Fatty Liver Disease. J Pediatr Gastroenterol Nutr 2022; 75:88-96. [PMID: 35442241 PMCID: PMC9283213 DOI: 10.1097/mpg.0000000000003461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Nonalcoholic fatty liver disease (NAFLD) is the leading chronic liver disease in youth, yet little is known about the adolescent patient's experience with NAFLD, which is key for treatment engagement. We examined adolescents' experiences with NAFLD diagnosis, thoughts on how NAFLD affects their daily life, understanding and perceptions of diagnosis and treatment, and impressions of how to improve care. METHODS Utilizing a mixed-method design, adolescents with NAFLD (N = 16; Mean age = 15.8 years; Mean BMI = 37 kg/m 2 ) participated in focus groups. To supplement qualitative data, adolescents and their caregiver completed measures assessing illness perceptions, adolescent quality of life, and eating/activity behaviors. RESULTS Focus group themes suggested reactions to diagnosis varied from unconcerned to anxious. NAFLD diagnosis occurred within the context of other psychological/medical concerns and was not perceived to affect most adolescents' daily lives. Although adolescents understood general contributors to NAFLD, comprehension of their diagnosis varied. Adolescents were more likely to make lifestyle changes when families were supportive, and they preferred tailored recommendations for health behavior change from the healthcare team. Notably, 62.5% of adolescents were more concerned about their weight than NAFLD. Almost half (43.8%) identified as food insecure. CONCLUSIONS Adolescents with NAFLD may benefit from personalized treatment. Care could be enhanced by ensuring comprehension of diagnosis, problem-solving personal, and family barriers and increasing family support. Harnessing adolescents' desire for weight loss may be a more salient driver for change in disease status. Interventions should also address systemic barriers such as food insecurity to ensure equitable care.
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Affiliation(s)
- Sanita L Ley
- From the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Katherine M Kidwell
- From the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Psychology, Syracuse University, Syracuse, NY
| | - Tori R Van Dyk
- Department of Psychology, Loma Linda University, Loma Linda, CA
| | - Sarah Orkin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Taylor Howarth
- From the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Amy R Goetz
- From the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Stavra A Xanthakos
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kristin Bramlage
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Psychology, Loma Linda University, Loma Linda, CA
| | - Marialena Mouzaki
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Ana Catalina Arce-Clachar
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Meg H Zeller
- From the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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Lee-Kim V, Morkem R, Barber D, Flemming JA, Kehar M. Awareness, management, and practice patterns of pediatric NAFLD by primary care physicians. Paediatr Child Health 2022; 27:93-98. [PMID: 35599680 DOI: 10.1093/pch/pxab057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 07/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children. Primary-care physicians (PCPs) play a key role in identifying patients requiring specialist referral. In this study, we aim to determine PCPs' practice patterns for paediatric NAFLD, as knowledge gaps have been reported for adult NAFLD. Methods A survey was sent to 60 PCPs in the Eastern Ontario Network from July 2019 to January 2020. Results Thirty-seven (62%) PCPs responded to the survey. Twenty-one incorrectly considered the prevalence of paediatric NAFLD to be ≤10%. The majority (35/36) cared for less than five paediatric NAFLD patients. Thirty-four (92%) were only 'slightly familiar' or 'not familiar at all' with paediatric NAFLD. Only one PCP routinely screens for NAFLD. Only one PCP was aware of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) clinical guidelines for paediatric NAFLD. Twenty-five (68%) correctly selected lifestyle modifications as a treatment option. Lack of confidence in the knowledge of NAFLD was the most common barrier for managing paediatric cases. Conclusion The majority of PCPs are not screening for paediatric NAFLD and are not familiar with its clinical spectrum, citing a lack of knowledge regarding NAFLD as the greatest barrier. This may cause delays in diagnosis and a presentation with advanced fibrosis at the time of specialist referral. Dissemination and implementation of clinical guidelines have the potential to improve knowledge and screening rates for NAFLD in children at the primary-care level.
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Affiliation(s)
- Victoria Lee-Kim
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Rachael Morkem
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - David Barber
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Jennifer A Flemming
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Mohit Kehar
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada.,Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Fatty Liver through the Ages- Non-Alcoholic Steatohepatitis (NASH). Endocr Pract 2021; 28:204-213. [PMID: 34952219 DOI: 10.1016/j.eprac.2021.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The global epidemic of obesity and type 2 diabetes mellitus is the main driver of the growing global prevalence of non-alcoholic fatty liver disease (NAFLD). We aimed to review the current literature on NAFLD and NASH as it impacts children and adults. METHODS We performed a literature search on fatty liver specifically non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) among children and adults. RESULTS The prevalence of NAFLD in children ranges from 8%-12% while the prevalence in adults ranges 25%-48%. The prevalence of NASH among children with NAFLD is 23% while it ranges from 13% to 65% in the adults. There are similar risk factors for NAFLD among children and adults. However, in children, the diagnostic tests in the studies of NAFLD are limited to elevation of ALT level or a liver biopsy. In adults, additional diagnostic modalities, including non-invasive tests (NITs), have been used. From the spectrum of NAFLD, those with NASH are predominantly at risk of progressive liver disease to cirrhosis and liver-related mortality. NAFLD is associated with impairment of health-related quality of life and substantial economic burden. CONCLUSION The comprehensive burden (clinical, HRQL and economic) of NAFLD is high and increasing.
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Grønkjær LL, Lauridsen MM. Quality of life and unmet needs in patients with chronic liver disease: A mixed-method systematic review. JHEP REPORTS : INNOVATION IN HEPATOLOGY 2021; 3:100370. [PMID: 34805816 PMCID: PMC8585663 DOI: 10.1016/j.jhepr.2021.100370] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/23/2021] [Accepted: 09/21/2021] [Indexed: 02/06/2023]
Abstract
Background & Aims In an attempt to uncover unmet patient needs, this review aims to synthesise quantitative and qualitative studies on patients’ quality of life and their experience of having liver disease. Methods Three databases (CINAHL, Embase, and PubMed) were searched from January 2000 to October 2020. The methodological quality and data extraction of both quantitative and qualitative studies were screened and appraised using Joanna Briggs Institute instruments for mixed-method systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A convergent, integrated approach to synthesis and integration was used. Studies including patients with autoimmune and cholestatic liver disease, chronic hepatitis B and C, non-alcoholic fatty liver disease and non-alcoholic steatohepatitis, cirrhosis, and hepatocellular carcinoma were considered. Results The searches produced 5,601 articles, of which 95 (79 quantitative and 16 qualitative) were included in the review. These represented studies from 26 countries and a sample of 37,283 patients. The studies showed that patients´ quality of life was reduced. Unmet needs for information and support and perceived stigmatisation severely affected patients’ quality of life. Conclusions Our study suggests changes to improve quality of life. According to patients, this could be achieved by providing better education and information, being aware of patients’ need for support, and raising awareness of liver disease among the general population to reduce misconceptions and stigmatisation. Registration number PROSPERO CRD42020173501. Lay summary Regardless of aetiology, patients with liver diseases have impaired quality of life. This is associated with disease progression, the presence of symptoms, treatment response, and mental, physical, and social factors such as anxiety, confusion, comorbidities, and fatigue, as well as limitations in daily living, including loneliness, low income, stigmatisation, and treatment costs. Patients highlighted the need for information to understand and manage liver disease, and awareness and support from healthcare professionals to better cope with the disease. In addition, there is a need to raise awareness of liver diseases in the general population to reduce negative preconceptions and stigmatisation. Patients with liver disease regardless of aetiology and severity have impaired quality of life. Patients call for better education and information to understand and manage their liver disease, and for increased awareness and support from healthcare professionals. Owing to the limited knowledge of liver diseases among the general population, patients experience stigmatisation, resulting in loneliness and social isolation. Addressing unmet needs of patients with liver disease could improve their quality of life.
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Key Words
- CLDQ, Chronic Liver Disease Questionnaire
- EQ-5D, European Quality of Life
- FACT-Hep, Functional Assessment of Cancer Therapy Hepatobiliary Carcinoma
- HBQOL, Hepatitis B Quality of Life
- HCC, hepatocellular carcinoma
- JBI, Joanna Briggs Institute
- LC-PROM, Liver Cirrhosis Patient Reported Outcome Measure
- LDQOL, Liver Disease Quality of Life
- Liver disease
- MELD, model for end-stage liver disease
- Mixed method
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- PBC, Primary Biliary Cholangitis Questionnaire
- Patient experience
- Patient reported outcomes
- PedsQL, Pediatric Quality of Life Inventory
- Quality of life
- SF, Short Form
- SIP, Sickness Impact Profile
- Systematic review
- Unmet needs
- VAS, visual analogue scale
- WHOQOL-BREF, WHO Quality of Life
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Affiliation(s)
- Lea Ladegaard Grønkjær
- Department of Gastroenterology, University Hospital of Southern Denmark, Esbjerg, Denmark
- Corresponding author. Address: Department of Gastroenterology, University Hospital of Southern Denmark, Finsensgade 35, 6700 Esbjerg, Denmark. Tel.: +45-26668184; Fax: +45-79182316.
| | - Mette Munk Lauridsen
- Department of Gastroenterology, University Hospital of Southern Denmark, Esbjerg, Denmark
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Evon DM, Lin HHS, Fontana RJ, Khalili M, Yim C, Wahed AS, Hoofnagle JH. Liver disease symptoms are associated with higher risk of adverse clinical outcomes: A longitudinal study of North American adults with chronic Hepatitis B. ACTA ACUST UNITED AC 2021; 3:196-208. [PMID: 34421369 DOI: 10.1002/ygh2.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Symptoms of chronic hepatitis B (CHB) are not well characterized. Aims To evaluate CHB symptoms and associations with disease activity and clinical outcomes. Methods Longitudinal data from 1,576 participants in the Hepatitis B Research Network Cohort Study who completed symptom assessments were analyzed. A composite symptom score was calculated using a Symptom Checklist (0=none to 40=extreme). Multivariable mixed models assessed variables associated with symptom change over time. Latent class symptom trajectories were evaluated. The cumulative probability of long-term clinical outcomes (new onset cirrhosis, hepatic decompensation, hepatocellular carcinoma, liver transplantation, death) was examined by baseline symptom groups. Results Participants median age was 42 (range:18-80), 51% were male, 75% Asian, (68% of whom were born outside North America) with a median follow-up of 4.2 years. On average, symptoms did not significantly change over time. The multivariable model identified several variables associated with higher symptoms during follow-up: being female, non-Asian, born in the US/Canada, lower education, higher AST, lower platelets, and more comorbidities. Two patient subgroups were identified based on longitudinal symptom trajectories: a low symptom group (92%, n=1,451) with symptom scores averaging 2.4 over time and a moderate symptom group (8%, n=125) with symptom scores averaging 11.5. During follow-up, 7.3% in the moderate symptom group, but only 3.2% of the low symptom group, developed adverse outcomes (p=0.02). Conclusions In this large cohort of CHB patients, symptoms were generally mild and stable over time. However, in some patients with moderate symptoms at baseline, deleterious clinical outcomes were more frequent in follow-up.
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Affiliation(s)
- Donna M Evon
- Department of Medicine, University of North Carolina at Chapel Hill
| | - Hsing-Hua S Lin
- Departments of Epidemiology and Biostatistics, University of Pittsburgh
| | | | - Mandana Khalili
- Department of Medicine, University of California at San Francisco
| | - Colina Yim
- Toronto Centre for Liver Disease, University of Toronto
| | - Abdus S Wahed
- Departments of Epidemiology and Biostatistics, University of Pittsburgh
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One Week of CDAHFD Induces Steatohepatitis and Mitochondrial Dysfunction with Oxidative Stress in Liver. Int J Mol Sci 2021; 22:ijms22115851. [PMID: 34072586 PMCID: PMC8198552 DOI: 10.3390/ijms22115851] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/20/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023] Open
Abstract
The prevalence of nonalcoholic fatty liver disease (NAFLD) has been rapidly increasing worldwide. A choline-deficient, L-amino acid-defined, high-fat diet (CDAHFD) has been used to create a mouse model of nonalcoholic steatohepatitis (NASH). There are some reports on the effects on mice of being fed a CDAHFD for long periods of 1 to 3 months. However, the effect of this diet over a short period is unknown. Therefore, we examined the effect of 1-week CDAHFD feeding on the mouse liver. Feeding a CDAHFD diet for only 1-week induced lipid droplet deposition in the liver with increasing activity of liver-derived enzymes in the plasma. On the other hand, it did not induce fibrosis or cirrhosis. Additionally, it was demonstrated that CDAHFD significantly impaired mitochondrial respiration with severe oxidative stress to the liver, which is associated with a decreasing mitochondrial DNA copy number and complex proteins. In the gene expression analysis of the liver, inflammatory and oxidative stress markers were significantly increased by CDAHFD. These results demonstrated that 1 week of feeding CDAHFD to mice induces steatohepatitis with mitochondrial dysfunction and severe oxidative stress, without fibrosis, which can partially mimic the early stage of NASH in humans.
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Huang R, Fan JG, Shi JP, Mao YM, Wang BY, Zhao JM, Lu LG, Zhong BH, Zou ZS, Xu YQ, Ye YN, Liu LG, Lin LJ, Li JP, Rao HY, Wei L. Health-related quality of life in Chinese population with non-alcoholic fatty liver disease: a national multicenter survey. Health Qual Life Outcomes 2021; 19:140. [PMID: 33962617 PMCID: PMC8106221 DOI: 10.1186/s12955-021-01778-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/22/2021] [Indexed: 12/25/2022] Open
Abstract
Background Health Related Quality of Life (HRQL) is a multi-dimensional construct that can comprehensively evaluate the patient’s health status, including physical, emotional, mental and social well-being. In this study, we aimed to evaluate the impact of non-alcoholic fatty liver disease (NAFLD) on HRQL in a Chinese population. Methods In this national multicenter cross-sectional survey, patients with NAFLD were enrolled. Chronic Liver Disease Questionnaire (CLDQ)-NAFLD was used to qualify HRQL. Univariate and multivariate analysis were used to identify independent risk factors of HRQL. Results A total of 5181 patients with NAFLD from 90 centers were enrolled in this study (mean age, 43.8 ± 13.3 years; male, 65.8%). The overall CLDQ score was 5.66 ± 0.89. Multivariate logistic regression analysis showed that body mass index (BMI: HR, 1.642; 95% CI, 1.330–2.026), alanine transaminase (ALT: HR, 1.006; 95% CI, 1.001–1.011), triglyceride (HR, 1.184; 95% CI, 1.074–1.305), disease severity (HR, 3.203; 95% CI, 1.418–7.232) and cardiovascular disease (HR, 4.305; 95% CI, 2.074–8.939) were independent risk factors for overall CLDQ score. In the logistic analyses of individual domain, BMI and triglyceride were independent risk factors of all domains. ALT, disease severity, diabetes, depression and cardiovascular disease were influencing factors for the CLDQ score of several domains. Conclusions This national multicenter cross-sectional survey in China indicated that the HRQL in patients with NAFLD was impaired. HRQL was found to be significantly associated with sociodemographic and clinical factors. Attention should be paid to the optimally managing care of patients with NAFLD to improve their HRQL.
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Affiliation(s)
- Rui Huang
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology On NAFLD Diagnosis, No.11 Xizhimen South Street, Beijing, 100044, China
| | - Jian-Gao Fan
- Department of Digestive, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun-Ping Shi
- Department of Hepatology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Yi-Min Mao
- Department of Digestive, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing-Yuan Wang
- Department of Digestive, The First Hospital of China Medical University, Shenyang, China
| | - Jing-Min Zhao
- Department of Pathology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Lun-Gen Lu
- Department of Digestive, The First People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bi-Hui Zhong
- Department of DigestiveThe First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zheng-Sheng Zou
- Department of Pathology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - You-Qing Xu
- Department of DigestiveBeijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Nong Ye
- Department of Infectious Disease, The First Hospital of Fushan, Fushan, China
| | - Long-Gen Liu
- Department of Hepatology, The Third People's Hospital, Changzhou, China
| | - Lian-Jie Lin
- Department of Digestive, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jian-Ping Li
- China Resources Sanjiu Medical and Pharmaceutical Co., Ltd, Shenzhen, China
| | - Hui-Ying Rao
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology On NAFLD Diagnosis, No.11 Xizhimen South Street, Beijing, 100044, China.
| | - Lai Wei
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, No.168, Litang Road, Changping District, Beijing, 102218, China.
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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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Gow ML, Pham-Short A, Jebeile H, Varley BJ, Craig ME. Current Perspectives on the Role of Very-Low-Energy Diets in the Treatment of Obesity and Type 2 Diabetes in Youth. Diabetes Metab Syndr Obes 2021; 14:215-225. [PMID: 33500642 PMCID: PMC7822089 DOI: 10.2147/dmso.s238419] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/06/2021] [Indexed: 12/21/2022] Open
Abstract
In both developed and developing countries, pediatric obesity and type 2 diabetes are an increasing public health concern: globally 5.6% of girls and 7.8% of boys aged ≥5 years have obesity. The incidence of type 2 diabetes has increased in youth in recent decades and disproportionately affects those from ethnic/racial minority groups and disadvantaged backgrounds. For the treatment of both conditions, conventional lifestyle intervention is frequently ineffective, access to bariatric surgery is very limited and many young people are unsuitable or unwilling to undergo surgery. A very-low-energy diet (VLED) provides a viable alternative and may be effective for weight reduction and improved glycemic control in youth, based on one systematic review. In particular, in the treatment of type 2 diabetes, a chart review and a pilot study both demonstrated that a VLED can reduce the requirement for medications, including insulin, and lead to the remission of diabetes. However, long-term follow-up and safety data remain limited and therefore a VLED is inconsistently recommended by clinical practice guidelines for the treatment of pediatric obesity and type 2 diabetes. In clinical practice, VLED use in children and adolescents is uniquely challenging due to intolerance of expected side effects, difficulty adhering to the highly restrictive diet and difficulty with behaviour change within the current social context and environment. Ultimately, more research, including larger, longer-term trials with comprehensive safety monitoring are required to strengthen the evidence base. This would inform clinical practice guidelines, which may facilitate more widespread utilization of VLED programs in the management of obesity and type 2 diabetes in youth.
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Affiliation(s)
- Megan L Gow
- The University of Sydney Children’s Hospital Westmead Clinical School, Sydney, NSW, Australia
- Correspondence: Megan L Gow The University of Sydney Children’s Hospital Westmead Clinical School, Sydney, NSW, AustraliaTel +61 2 9845 0000Fax +61 2 9845 3170 Email
| | - Anna Pham-Short
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Hiba Jebeile
- The University of Sydney Children’s Hospital Westmead Clinical School, Sydney, NSW, Australia
| | - Benjamin J Varley
- The University of Sydney Children’s Hospital Westmead Clinical School, Sydney, NSW, Australia
| | - Maria E Craig
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
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Kim A, Yang HR, Cho JM, Chang JY, Moon JS, Ko JS. A Nomogram for Predicting Non-Alcoholic Fatty Liver Disease in Obese Children. Pediatr Gastroenterol Hepatol Nutr 2020; 23:276-285. [PMID: 32483549 PMCID: PMC7231740 DOI: 10.5223/pghn.2020.23.3.276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/15/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Non-alcoholic fatty liver disease (NAFLD) ranges in severity from simple steatosis to steatohepatitis. Early detection of NAFLD is important for preventing the disease from progressing to become an irreversible end-stage liver disease. We developed a nomogram that allows for non-invasive screening for NAFLD in obese children. METHODS Anthropometric and laboratory data of 180 patients from our pediatric obesity clinic were collected. Diagnoses of NAFLD were based on abdominal ultrasonographic findings. The nomogram was constructed using predictors from a multivariate analysis of NAFLD risk factors. RESULTS The subjects were divided into non-NAFLD (n=67) and NAFLD groups (n=113). Factors, including sex, body mass index, abdominal circumference, blood pressure, insulin resistance, and levels of aspartate aminotransferase, alanine aminotransferase (ALT), γ-glutamyl transpeptidase (γGT), uric acid, triglycerides, and insulin, were significantly different between the two groups (all p<0.05) as determined using homeostatis model assessment of insulin resistance (HOMA-IR). In our multivariate logistic regression analysis, elevated serum ALT, γGT, and triglyceride levels were significantly related to NAFLD development. The nomogram was established using γGT, uric acid, triglycerides, HOMA-IR, and ALT as predictors of NAFLD probability. CONCLUSION The newly developed nomogram may help predict NAFLD risk in obese children. The nomogram may also allow for early NAFLD diagnosis without the need for invasive liver biopsy or expensive liver imaging, and may also allow clinicians to intervene early to prevent the progression of NAFLD to become a more advanced liver disease.
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Affiliation(s)
- Ahlee Kim
- Department of Pediatrics, Bundang Jasaeng General Hospital, Seongnam, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Min Cho
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ju Young Chang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Sung Ko
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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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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Wang H, Zhou Y, Yan R, Ru GQ, Yu LL, Yao J. Fatigue in chronic hepatitis B patients is significant and associates with autonomic dysfunction. Health Qual Life Outcomes 2019; 17:130. [PMID: 31345232 PMCID: PMC6659270 DOI: 10.1186/s12955-019-1200-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 07/18/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fatigue is an important clinical finding in patients with chronic hepatitis virus infection. However, studies assessing fatigue in patients with chronic hepatitis B (CHB) are very limited. This study aimed to quantify the severity of fatigue in patients with CHB, to determine whether perceived fatigue reflects impairment of functional ability, and to explore potential causes. METHODS A total of 133 patients with histologically proven CHB and 59 community controls were assessed using the fatigue impact scale (FIS). RESULTS The degree of fatigue was significantly higher in patients with CHB than in controls (mean (range) FIS 24.9 (0-91) vs. 15.7 (0-31), p < 0.001). Fatigue experienced by patients with CHB was similar to that in primary biliary cirrhosis (PBC) (n = 20) (FIS 22.2 vs. 20.9, p = 0.28). No association was found between FIS and biochemistry and histological parameters of liver disease severity. Significant associations were found between fatigue severity and cognitive impairment (r = 0.39, p < 0.001), daytime somnolence (r = 0.32, p < 0.001), scores of the Chronic Liver Disease Questionnaire (r = - 0.31, p < 0.001), and autonomic symptoms (r = 0.43, p < 0.001). The level of autonomic symptom was the only factor independently associated with the degree of fatigue. CONCLUSION Fatigue is a significant problem of functional ability impairment in CHB and similar in degree to that in PBC patients. Fatigue in patients with CHB appears to be unrelated to the severity of liver disease but is associated with significant autonomic symptoms.
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Affiliation(s)
- Hong Wang
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital, People’s Hospital Hang Zhou Medical College, 108, Shan Tang Road, Hangzhou, 310016 Zhejiang Province China
| | - Ying Zhou
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital, People’s Hospital Hang Zhou Medical College, 108, Shan Tang Road, Hangzhou, 310016 Zhejiang Province China
| | - Rong Yan
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital, People’s Hospital Hang Zhou Medical College, 108, Shan Tang Road, Hangzhou, 310016 Zhejiang Province China
| | - Guo Qing Ru
- Department of Pathology, Zhejiang Provincial People’s Hospital, People’s Hospital Hang Zhou Medical College, Zhejiang, China
| | - Li Li Yu
- Department of Pathology, Zhejiang Provincial People’s Hospital, People’s Hospital Hang Zhou Medical College, Zhejiang, China
| | - Jiong Yao
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital, People’s Hospital Hang Zhou Medical College, 108, Shan Tang Road, Hangzhou, 310016 Zhejiang Province China
- Department of Medical Record Statistic Information, Zhejiang Provincial People’s Hospital, People’s Hospital Hang Zhou Medical College, Zhejiang, China
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Lee RLT, Chien WT, Tanida K, Takeuchi S, Rutja P, Kwok SWH, Lee PH. The Association between Demographic Characteristics, Lifestyle Health Behaviours, and Quality of Life among Adolescents in Asia Pacific Region. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2324. [PMID: 31266150 PMCID: PMC6651512 DOI: 10.3390/ijerph16132324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/17/2019] [Accepted: 06/21/2019] [Indexed: 11/30/2022]
Abstract
Background: Given the risk of physical and psychosocial health that emerge in adolescents that are continuing into adulthood, identifying and addressing early signs of health-related quality of life (HRQoL) decline provides an opportunity to ensure that young people have a healthier progression through adolescence. Aim: To investigate the association between demographic characteristics, lifestyle health behaviours, and HRQoL of adolescents who live in Asia Pacific region, including Hong Kong in China, Beijing in China, Akashi in Japan, Seoul in South Korea, and Bangkok in Thailand. Methods: A cross-sectional self-reported survey carried out in a sample of 2296 adolescents that were aged 9-16 years (mean= 12.0; standard deviation [SD] = 1.63) was conducted in the five cities of the Asia Pacific region between January and August 2017. Demographic characteristics, adolescent lifestyle behaviours, and HRQoL were measured with demographic questionnaire, Adolescent Lifestyle Questionnaire's (ALQ) seven domains and Paediatric Quality of Life's (PedsQL 4.0) global score, respectively. Mixed multilevel model (MMLM) was used to fit the data. Results: After adjusting the demographic variables, one score increase in ALQ physical participation, nutrition, social support, and identity awareness are associated with an increase in PedsQL global score. On the contrary, one score increase in ALQ health practices is associated with a decrease in the PedsQL global score. The estimated mean of PedsQL global score of South Korea, Beijing, and Japan were better, while the score of Thailand and Hong Kong were poorer. Conclusions: Differentiating the impacts of promoting health behaviours among different countries can help in better understanding the health needs of adolescents in each country, especially in the Asia Pacific region, so that adequate and relevant resources can be allocated to reduce health-risk taking behaviours among this vulnerable group for health-promoting strategies.
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Affiliation(s)
- Regina L T Lee
- Faculty of Health and Medicine, School of Nursing and Midwifery, The University of Newcastle, Callaghan 2308, New South Wales, Australia.
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Keiko Tanida
- College of Nursing Art and Science, University of Hyogo, World Health Organization Collaborating Center for Nursing in Disasters and Health Emergency, Hyogo 13-71 Kitaoji-cho, Japan
| | - Sachi Takeuchi
- College of Nursing Art and Science, University of Hyogo, World Health Organization Collaborating Center for Nursing in Disasters and Health Emergency, Hyogo 13-71 Kitaoji-cho, Japan
| | - Phuphaibul Rutja
- Ramathibodi School of Nursing, Faculty of Medicine, World Health Organization Collaborating Center, Krung Thep Maha Nakhon 10400, Thailand
| | - Stephen W H Kwok
- School of Nursing, World Health Organization Collaborating Center for Community Health Services, The Hong Kong Polytechnic University, Hong Kong, China
| | - Paul H Lee
- School of Nursing, World Health Organization Collaborating Center for Community Health Services, The Hong Kong Polytechnic University, Hong Kong, China
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Abdelbasset WK, Tantawy SA, Kamel DM, Alqahtani BA, Soliman GS. A randomized controlled trial on the effectiveness of 8-week high-intensity interval exercise on intrahepatic triglycerides, visceral lipids, and health-related quality of life in diabetic obese patients with nonalcoholic fatty liver disease. Medicine (Baltimore) 2019; 98:e14918. [PMID: 30896648 PMCID: PMC6708753 DOI: 10.1097/md.0000000000014918] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Medications are limited for patients with nonalcoholic fatty liver disease (NAFLD). It has been reported that aerobic exercise is effective in reducing the characteristics of NAFLD, although unclear data have ascertained the effects of high-intensity interval aerobic exercise on health-related quality of life (HRQoL) in diabetic obese patients with NAFLD. OBJECTIVES This a randomized controlled trial aimed to ascertain the effectiveness of 8-week high-intensity interval exercise on intrahepatic triglycerides (IHTG), visceral lipids and HRQoL in diabetic obese patients with NAFLD. STUDY DESIGN Between August and December 2017, 32 diabetic obese patients with NAFLD aged 45 to 60 years (21 men and 11 women) were enrolled in this study. They were randomly assigned to 2 groups, 16 patients in each group, high-intensity interval (HII) exercise and control groups. The HII group received a program of HII aerobic exercise for 8 weeks with medications of NAFLD and the control group received only medications without any type of exercise intervention. The test of IHTG, visceral lipids, and HRQoL were recorded at the initial assessment and at the end of the program after 8 weeks. RESULTS There were significant differences between the 2 groups at the end of the study. These study findings exhibited significant improvements in IHTG, VO2peak, visceral lipids, glycohemoglobin, plasma glucose, and all dimensions of HRQoL in the HII group (P <.05), But there was non-significant improvement in any measure in the control group (P >.05) after the 8-week intervention. CONCLUSION Eight-week high-intensity interval aerobic exercise has a beneficial effect on IHTG, visceral lipids, and HRQoL in diabetic obese patients with NAFLD. Effort and awareness should be dedicated to encouraging the active lifestyle among different population, especially diabetic obese patients with NAFLD.
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Affiliation(s)
- Walid Kamal Abdelbasset
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
- Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
| | - Sayed A. Tantawy
- Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Kingdom of Bahrain
- Department of Physiotherapy, Centre of Radiation, Oncology and Nuclear Medicine
| | - Dalia M. Kamel
- Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Kingdom of Bahrain
- Department of Physiotherapy for Women's Health, Faculty of Physical Therapy
| | - Bader A. Alqahtani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Gaber S. Soliman
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences in Al-Qurayyat, Jouf University, Saudi Arabia
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Understanding susceptibility and targeting treatment in non-alcoholic fatty liver disease in children; moving the fulcrum. Proc Nutr Soc 2019; 78:362-371. [DOI: 10.1017/s0029665118002914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of paediatric liver disease, affecting 10% of school-aged children and 44–70% of obese children and young people (CYP) in the western world. Encompassing a spectrum from simple steatosis to steatohepatitis and progressive fibrosis, the disease is rapidly becoming the most common indication for liver transplantation. The molecular pathogenesis of NAFLD remains only partially understood. Development and progression of NAFLD is influenced by genetic and nutritional factors, insulin resistance, oxidative stress, gut microbiome, bile acid metabolism and lipid/glucose handling and is closely associated with overweight and obesity. Lifestyle change is the only proven effective treatment for paediatric NAFLD, however this is difficult to achieve in many. Given that moderate or severe fibrosis is already present in 30–50% of children with NAFLD at the time of presentation, progression in CYP may be more rapid, though adequate outcome data do not yet exist in this cohort. CYP with NAFLD are an excellent population in which to study underlying mechanisms and interventions to correct disease progression as they are largely unaffected by other environmental influences such as alcohol and may represent the more severe end of the spectrum in terms of early onset. Undoubtedly genetic and epigenetic mechanisms determine a large proportion of susceptibility to the disease and potentially, identification of individuals at risk may allow for targeted therapy. This review with give a clinical perspective of paediatric NAFLD focused on identifying those at risk of progressive disease and what to consider in attempting to modify risk.
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Clinical Practice Approach to Nonalcoholic Fatty Liver Disease by Pediatric Gastroenterologists in the United States. J Pediatr Gastroenterol Nutr 2019; 68:182-189. [PMID: 30640271 PMCID: PMC8053385 DOI: 10.1097/mpg.0000000000002194] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Nonalcoholic fatty liver disease (NAFLD) is common; however, no information is available on how pediatric gastroenterologists in the United States manage NAFLD. Therefore, study objectives were to understand how pediatric gastroenterologists in the US approach the management of NAFLD, and to identify barriers to care for children with NAFLD. METHODS We performed structured one-on-one interviews to ascertain each individual pediatric gastroenterologist's approach to the management of NAFLD in children. Responses were recorded from open-ended questions regarding screening for comorbidities, recommendations regarding nutrition, physical activity, medications, and perceived barriers to care. RESULTS Response rate was 72.0% (486/675). Mean number of patients examined per week was 3 (standard deviation [SD] 3.5). Dietary intervention was recommended by 98.4% of pediatric gastroenterologists. Notably, 18 different dietary recommendations were reported. A majority of physicians provided targets for exercise frequency (72.6%, mean 5.6 days/wk, SD 1.6) and duration (69.9%, mean 40.2 minutes/session, SD 16.4). Medications were prescribed by 50.6%. Almost one-half of physicians (47.5%) screened for type 2 diabetes, dyslipidemia, and hypertension. Providers who spent more than 25 minutes at the initial visit were more likely to screen for comorbidities (P = 0.003). Barriers to care were reported by 92.8% with 29.0% reporting ≥3 barriers. CONCLUSIONS The majority of US pediatric gastroenterologists regularly encounter children with NAFLD. Varied recommendations regarding diet and exercise highlight the need for prospective clinical trials. NAFLD requires a multidimensional approach with adequate resources in the home, community, and clinical setting.
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Karaivazoglou K, Kalogeropoulou M, Assimakopoulos S, Triantos C. Psychosocial Issues in Pediatric Nonalcoholic Fatty Liver Disease. PSYCHOSOMATICS 2019; 60:10-17. [PMID: 30318268 DOI: 10.1016/j.psym.2018.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND In recent years, the adoption of unhealthy dietary habits and a sedentary lifestyle has led to an alarming increase in the prevalence of non-alcoholic fatty liver disease (NAFLD) in pediatric populations. Hepatic steatosis is now considered the most common cause of chronic liver disease in children and adolescents and may progress to liver fibrosis and even cirrhosis, increasing long-term mortality rates. Apart from its severe medical co-morbidities, pediatric NAFLD is associated with a variety of psychosocial factors which act either as precipitants or consequences of the disease. OBJECTIVE Studying these parameters might expand our understanding of NAFLD pathogenesis and provide a framework for more effective management. METHOD In this context, we performed a literature review focusing on the associations of pediatric NAFLD with psychosocial parameters to detect and integrate the most recent data on this topic and provide a scaffold for further conceptualization and research. RESULTS There are a limited number of studies addressing issues of psychosocial functioning in children with NAFLD. Pediatric NAFLD is frequently accompanied by neuropsychiatric symptoms and poor quality of life and the level of impairment does not correlate with the degree of hepatic damage. In addition, mentally and intellectually-impaired youth appear at greater risk for developing liver steatosis. CONCLUSIONS Pediatric NAFLD is associated with psychosocial parameters in a bidirectional way. Further research is needed on NAFLD's psychosocial correlates and on the effect of treatment on patients' well-being.
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Affiliation(s)
| | - Maria Kalogeropoulou
- Department of Psychiatry, School of Medicine, University of Patras, Patras, Greece
| | - Stelios Assimakopoulos
- Division of Infectious Diseases, Department of Internal Medicine, University General Hospital of Patras, Patras, Greece
| | - Christos Triantos
- Department of Gastroenterology, School of Medicine, University of Patras, Patras, Greece.
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Abstract
Pediatric nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in children. The spectrum of NAFLD ranges from steatosis to nonalcoholic steatohepatitis (NASH) to fibrosis. Obesity rates in children continue to rise and, as a result, NAFLD in children is becoming more prevalent. The pathophysiology, natural history, and progression of disease are still being elucidated but NAFLD/NASH in children may represent a more severe phenotype that will benefit from early identification and management.
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Affiliation(s)
- Sara Kathryn Smith
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, University of California, San Francisco, 550 16th Street, 5th Floor, Mail Code 0136, San Francisco, CA 94143, USA.
| | - Emily R Perito
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, University of California, San Francisco, 550 16th Street, 5th Floor, Mail Code 0136, San Francisco, CA 94143, USA
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26
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Selvakumar PKC, Kabbany MN, Nobili V, Alkhouri N. Nonalcoholic Fatty Liver Disease in Children: Hepatic and Extrahepatic Complications. Pediatr Clin North Am 2017; 64:659-675. [PMID: 28502444 DOI: 10.1016/j.pcl.2017.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of metabolic syndrome and has become the most common form of chronic liver disease in children and adolescents. The histologic spectrum of NAFLD is broad ranging, from the relatively benign form of simple steatosis to the aggressive form of nonalcoholic steatohepatitis, eventually leading to fibrosis and cirrhosis. NAFLD has also been recognized as an independent risk factor for extrahepatic complications, such as cardiovascular disease, type 2 diabetes mellitus, sleep disorders, and osteoporosis. In this review, we discuss both the hepatic and extrahepatic complications of NAFLD in children.
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Affiliation(s)
| | - Mohammad Nasser Kabbany
- Department of Pediatric Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Valerio Nobili
- Liver Unit, IRCCS Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Naim Alkhouri
- Department of Pediatric Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Cleveland, Cleveland Clinic Main Campus, Mail Code A111, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children: Recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr 2017; 64:319-334. [PMID: 28107283 PMCID: PMC5413933 DOI: 10.1097/mpg.0000000000001482] [Citation(s) in RCA: 619] [Impact Index Per Article: 88.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent chronic liver disease that occurs in the setting of insulin resistance and increased adiposity. It has rapidly evolved into the most common liver disease seen in the pediatric population and is a management challenge for general pediatric practitioners, subspecialists, and for health systems. In this guideline, the expert committee on NAFLD reviewed and summarized the available literature, formulating recommendations to guide screening and clinical care of children with NAFLD.
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Karam V, Sebagh M, Rifai K, Yilmaz F, Bhangui P, Danet C, Saliba F, Samuel D, Castaing D, Adam R, Feray C. Quality of life 10 years after liver transplantation: The impact of graft histology. World J Transplant 2016; 6:703-711. [PMID: 28058221 PMCID: PMC5175229 DOI: 10.5500/wjt.v6.i4.703] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/06/2016] [Accepted: 09/22/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the relationship between the state of transplanted liver graft and the recipient quality of life (QOL) of histologically proven lesions in a 10-year post liver transplantation (LT) cohort of patients.
METHODS Seventy-two recipients with a functional first graft at 10 years post-LT underwent liver biopsy and completed a QOL questionnaire. Logistic regression analysis was used to explore associations between histological, clinical and QOL criteria.
RESULTS Ten years after LT, fibrosis was detected in 53% of patients, and affected the general health perception, while ductopenia, present in 36%, affected the well-being (P = 0.05). Hepatic steatosis (HS) was present in 33% of patients and was associated with the worst QOL score on multiple domains. When compared to patients without HS, patients with HS had significantly higher incidence of fibrosis (P = 0.03), hepatitis C virus (HCV) infection (P = 0.007), and more patients had retired from their job (P = 0.03). Recurrent or de novo HCV-associated fibrosis and patient retirement as objective variables, and abdominal pain or discomfort and joint aches or pains as subjective variables, emerged as independent determinants of HS.
CONCLUSION Long-term liver graft lesions, mainly HS presumably as a surrogate marker of HCV infection, may have a substantial impact on QOL 10 years after LT.
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Barat P, Meiffred MC, Brossaud J, Fuchs D, Corcuff JB, Thibault H, Capuron L. Inflammatory, endocrine and metabolic correlates of fatigue in obese children. Psychoneuroendocrinology 2016; 74:158-163. [PMID: 27627133 DOI: 10.1016/j.psyneuen.2016.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/02/2016] [Accepted: 09/07/2016] [Indexed: 02/07/2023]
Abstract
Alterations in endocrine functions and low-grade systemic inflammation represent fundamental characteristics of obesity. These biological systems have been repeatedly linked to fatigue symptoms. The aim of the study was to assess the relationship between fatigue dimensions and metabolic/inflammatory markers in a sample of non-diabetic obese children. The possibility that inflammation-induced alterations in tryptophan metabolism relates to specific dimensions of fatigue was also investigated in a subsample of patients. The study was conducted in 41 obese children, median aged 12 [9-15] years, recruited in a pediatric tertiary center. Three dimensions of fatigue (e.g., general fatigue, sleep/rest, cognitive fatigue) were assessed using the Pediatric Quality of Life Inventory Multidimentional Fatigue Scale. In addition, a principal component analysis was performed to identify fatigue dimensions that were specific to the population under study. This analysis extracted five relevant dimensions corresponding respectively to concentration, energy, self-perceived cognitive efficiency, sleep/rest and motivation/anhedonia. Blood samples were collected for the measurement of inflammatory and metabolic markers, including high sensitivity C-reactive protein (hs-CRP), insulin, uricemia and glycaemia. Tryptophan, kynurenine and neopterin levels were also determined in a subsample of 17 patients. In the whole population under study, cognitive fatigue and reduced motivation/anhedonia were associated with BMI, independently of sex and age. The dimension of reduced motivation/anhedonia was associated with insulin resistance and inflammatory biomarkers. The association with insulin resistance persisted when the extent of fat mass (BMI-SDS) was taken into account. No association was found between tryptophan metabolism and specific dimensions of fatigue, but kynurenine and the kynurenine/tryptophan ratio correlated with insulin and HOMA-IR. These data indicate that insulin resistance in non diabetic obese children is associated with both cognitive fatigue and reduced motivation/anhedonia and with alterations in tryptophan metabolism. Further investigations are needed to determine whether inflammation-induced alterations in tryptophan metabolism is directly or indirectly implicated in insulin resistance and related fatigue.
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Affiliation(s)
- Pascal Barat
- CHU Bordeaux, Centre Spécialise Obésité, Hopital des Enfants, F-33076 Bordeaux, France; Univ Bordeaux, Nutrition and Integrative Neurobiology, F-33076 Bordeaux, France.
| | - Marie-Claire Meiffred
- CHU Bordeaux, Centre Spécialise Obésité, Hopital des Enfants, F-33076 Bordeaux, France
| | - Julie Brossaud
- Univ Bordeaux, Nutrition and Integrative Neurobiology, F-33076 Bordeaux, France; CHU Bordeaux, Nuclear Medecine, F-33604 Pessac, France
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter Innsbruck Medical University Center for Chemistry and Biomedicine, A-6020 Innsbruck, Austria
| | - Jean-Benoit Corcuff
- Univ Bordeaux, Nutrition and Integrative Neurobiology, F-33076 Bordeaux, France; CHU Bordeaux, Nuclear Medecine, F-33604 Pessac, France
| | - Helene Thibault
- CHU Bordeaux, Centre Spécialise Obésité, Hopital des Enfants, F-33076 Bordeaux, France
| | - Lucile Capuron
- Univ Bordeaux, Nutrition and Integrative Neurobiology, F-33076 Bordeaux, France; INRA, Nutrition and Integrative Neurobiology, F-33076 Bordeaux, France
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Schwimmer JB, Lavine JE, Wilson LA, Neuschwander-Tetri BA, Xanthakos SA, Kohli R, Barlow SE, Vos MB, Karpen SJ, Molleston JP, Whitington PF, Rosenthal P, Jain AK, Murray KF, Brunt EM, Kleiner DE, Van Natta ML, Clark JM, Tonascia J, Doo E. In Children With Nonalcoholic Fatty Liver Disease, Cysteamine Bitartrate Delayed Release Improves Liver Enzymes but Does Not Reduce Disease Activity Scores. Gastroenterology 2016; 151:1141-1154.e9. [PMID: 27569726 PMCID: PMC5124386 DOI: 10.1053/j.gastro.2016.08.027] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND & AIMS No treatment for nonalcoholic fatty liver disease (NAFLD) has been approved by regulatory agencies. We performed a randomized controlled trial to determine whether 52 weeks of cysteamine bitartrate delayed release (CBDR) reduces the severity of liver disease in children with NAFLD. METHODS We performed a double-masked trial of 169 children with NAFLD activity scores of 4 or higher at 10 centers. From June 2012 to January 2014, the patients were assigned randomly to receive CBDR or placebo twice daily (300 mg for patients weighing ≤65 kg, 375 mg for patients weighing >65 to 80 kg, and 450 mg for patients weighing >80 kg) for 52 weeks. The primary outcome from the intention-to-treat analysis was improvement in liver histology over 52 weeks, defined as a decrease in the NAFLD activity score of 2 points or more without worsening fibrosis; patients without biopsy specimens from week 52 (17 in the CBDR group and 6 in the placebo group) were considered nonresponders. We calculated the relative risks (RR) of improvement using a stratified Cochran-Mantel-Haenszel analysis. RESULTS There was no significant difference between groups in the primary outcome (28% of children in the CBDR group vs 22% in the placebo group; RR, 1.3; 95% confidence interval [CI], 0.8-2.1; P = .34). However, children receiving CBDR had significant changes in prespecified secondary outcomes: reduced mean levels of alanine aminotransferase (reduction, 53 ± 88 U/L vs 8 ± 77 U/L in the placebo group; P = .02) and aspartate aminotransferase (reduction, 31 ± 52 vs 4 ± 36 U/L in the placebo group; P = .008), and a larger proportion had reduced lobular inflammation (36% in the CBDR group vs 21% in the placebo group; RR, 1.8; 95% CI, 1.1-2.9; P = .03). In a post hoc analysis of children weighing 65 kg or less, those taking CBDR had a 4-fold better chance of histologic improvement (observed in 50% of children in the CBDR group vs 13% in the placebo group; RR, 4.0; 95% CI, 1.3-12.3; P = .005). CONCLUSIONS In a randomized trial, we found that 1 year of CBDR did not reduce overall histologic markers of NAFLD compared with placebo in children. Children receiving CBDR, however, had significant reductions in serum aminotransferase levels and lobular inflammation. ClinicalTrials.gov no: NCT01529268.
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Affiliation(s)
- 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.
| | - Joel E Lavine
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University, and Morgan Stanley Children's Hospital of New York Presbyterian, New York, New York
| | - Laura A Wilson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Stavra A Xanthakos
- Steatohepatitis Center, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rohit Kohli
- Steatohepatitis Center, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sarah E Barlow
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Miriam B Vos
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Saul J Karpen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Jean P Molleston
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Indiana University School of Medicine/Riley Hospital for Children, Indianapolis, Indiana
| | - Peter F Whitington
- Department of Pediatrics, Feinberg Medical School of Northwestern University and the Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Philip Rosenthal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Francisco Benioff Children's Hospital, San Francisco, California
| | - Ajay K Jain
- Department of Pediatrics, St. Louis University, St. Louis, Missouri
| | - Karen F Murray
- Division of Gastroenterology and Hepatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's, Seattle, Washington
| | - Elizabeth M Brunt
- Department of Pathology, Washington University in St. Louis, St. Louis, Missouri
| | | | - Mark L Van Natta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jeanne M Clark
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - James Tonascia
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Edward Doo
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Newton KP, Hou J, Crimmins NA, Lavine JE, Barlow SE, Xanthakos SA, Africa J, Behling C, Donithan M, Clark JM, Schwimmer JB. Prevalence of Prediabetes and Type 2 Diabetes in Children With Nonalcoholic Fatty Liver Disease. JAMA Pediatr 2016; 170:e161971. [PMID: 27478956 PMCID: PMC5479314 DOI: 10.1001/jamapediatrics.2016.1971] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Nonalcoholic fatty liver disease (NAFLD) is a major chronic liver disease in children in the United States and is associated with insulin resistance. In adults, NAFLD is also associated with type 2 diabetes. To our knowledge, the prevalence of type 2 diabetes in children with NAFLD is unknown. OBJECTIVE To determine the prevalence of type 2 diabetes and prediabetes in children with NAFLD and assess type 2 diabetes and prediabetes as risk factors for nonalcoholic steatohepatitis (NASH). DESIGN, SETTING, AND PARTICIPANTS This was a multicenter, cross-sectional study at 12 pediatric clinical centers across the United States participating in the National Institute of Diabetes and Digestive and Kidney Diseases NASH Clinical Research Network. Children younger than 18 years with biopsy-confirmed NAFLD enrolled in the NASH Clinical Research Network. MAIN OUTCOMES AND MEASURES The presence of type 2 diabetes and prediabetes as determined by American Diabetes Association screening criteria using clinical history and fasting laboratory values. RESULTS There were 675 children with NAFLD included in the study with a mean age of 12.6 years and mean body mass index (calculated as weight in kilograms divided by height in meters squared) of 32.5. Most of the children were boys (480 of 675) and Hispanic (445 of 675).The estimated prevalence of prediabetes was 23.4% (95% CI, 20.2%-26.6%), and the estimated prevalence of type 2 diabetes was 6.5% (95% CI, 4.6%-8.4%). Girls with NAFLD had 1.6 (95% CI, 1.04-2.40) times greater odds of having prediabetes and 5.0 (95% CI, 2.49-9.98) times greater odds of having type 2 diabetes than boys with NAFLD. The prevalence of NASH was higher in those with type 2 diabetes (43.2%) compared with prediabetes (34.2%) or normal glucose (22%) (P < .001). The odds of having NASH were significantly higher in those with prediabetes (OR, 1.9; 95% CI, 1.21-2.9) or type 2 diabetes (OR, 3.1; 95% CI, 1.5-6.2) compared with those with normal glucose. CONCLUSIONS AND RELEVANCE In this study, nearly 30% of children with NAFLD also had type 2 diabetes or prediabetes. These children had greater odds of having NASH and thus were at greater long-term risk for adverse hepatic outcomes.
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Affiliation(s)
- Kimberly P. Newton
- 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
| | - Jiayi Hou
- Clinical and Translational Research Institute, University of California San Diego School of Medicine, La Jolla, California
| | - Nancy A. Crimmins
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Joel E. Lavine
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University, New York, NY
| | - Sarah E. Barlow
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, TX
| | - Stavra A. Xanthakos
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio,Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center
| | - Jonathan Africa
- 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
| | - Cynthia Behling
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California,Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center
| | - Michele Donithan
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Jeanne M. Clark
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD,Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - 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,Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, San Diego, California
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Achmad E, Yokoo T, Hamilton G, Heba ER, Hooker JC, Changchien C, Schroeder M, Wolfson T, Gamst A, Schwimmer JB, Lavine JE, Sirlin CB, Middleton MS. Feasibility of and agreement between MR imaging and spectroscopic estimation of hepatic proton density fat fraction in children with known or suspected nonalcoholic fatty liver disease. ACTA ACUST UNITED AC 2016. [PMID: 26205992 DOI: 10.1007/s00261-015-0506-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess feasibility of and agreement between magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) for estimating hepatic proton density fat fraction (PDFF) in children with known or suspected nonalcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS Children were included in this study from two previous research studies in each of which three MRI and three MRS acquisitions were obtained. Sequence acceptability, and MRI- and MRS-estimated PDFF were evaluated. Agreement of MRI- with MRS-estimated hepatic PDFF was assessed by linear regression and Bland-Altman analysis. Age, sex, BMI-Z score, acquisition time, and artifact score effects on MRI- and MRS-estimated PDFF agreement were assessed by multiple linear regression. RESULTS Eighty-six children (61 boys and 25 girls) were included in this study. Slope and intercept from regressing MRS-PDFF on MRI-PDFF were 0.969 and 1.591%, respectively, and the Bland-Altman bias and 95% limits of agreement were 1.17% ± 2.61%. MRI motion artifact score was higher in boys than girls (by 0.21, p = 0.021). Higher BMI-Z score was associated with lower agreement between MRS and MRI (p = 0.045). CONCLUSION Hepatic PDFF estimation by both MRI and MRS is feasible, and MRI- and MRS-estimated PDFF agree closely in children with known or suspected NAFLD.
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Affiliation(s)
- Emil Achmad
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Takeshi Yokoo
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
- Department of Radiology and Advanced Imaging Research Center, UT Southwestern School of Medicine, Dallas, TX, USA
| | - Gavin Hamilton
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Elhamy R Heba
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Jonathan C Hooker
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Christopher Changchien
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Michael Schroeder
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory (CASL), San Diego Supercomputing Center (SDSC), University of California, San Diego, San Diego, CA, USA
| | - Anthony Gamst
- Computational and Applied Statistics Laboratory (CASL), San Diego Supercomputing Center (SDSC), University of California, San Diego, San Diego, CA, USA
| | - Jeffrey B Schwimmer
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, School of Medicine, University of California, San Diego, San Diego, CA, USA
- Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Joel E Lavine
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Michael S Middleton
- Liver Imaging Group, Department of Radiology, School of Medicine, University of California, San Diego, San Diego, CA, USA.
- UCSD Department of Radiology, UCSD MRI Institute, 410 West Dickinson Street, San Diego, CA, 92103-8749, USA.
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Frontini R, Gouveia MJ, Moreira H, Canavarro MC. Adaptação psicossocial na obesidade pediátrica: Um estudo com pais, crianças e adolescentes. PSYCHOLOGY, COMMUNITY & HEALTH 2016. [DOI: 10.5964/pch.v5i2.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo Os objetivos do presente estudo são 1) comparar a qualidade de vida (QdV) e os problemas psicológicos de crianças/adolescentes com obesidade, excesso de peso e peso saudável, e a QdV e sintomas de depressão e ansiedade dos seus pais; 2) averiguar se a adaptação psicossocial dos pais está associada à QdV das crianças/adolescentes através dos seus problemas psicológicos e se estas associações são moderadas pela idade da criança/adolescente. Método A amostra foi constituída por 264 díades pais-filhos divididas em 3 grupos (peso saudável, excesso de peso e obesidade). Resultados As crianças/adolescentes com obesidade reportaram pior QdV e maiores níveis de problemas psicológicos do que as crianças/adolescentes com peso saudável. Os adolescentes reportaram pior QdV do que as crianças. Os pais das crianças/adolescentes com obesidade reportaram pior QdV e mais sintomas ansiosos e depressivos comparativamente aos pais das crianças/adolescentes com peso saudável. A associação entre ansiedade dos pais e a QdV das crianças/adolescentes foi mediada pelos problemas psicológicos dos adolescentes. Conclusão É fundamental a implementação de intervenções multidisciplinares focadas na família, que visem a perda de peso da criança/adolescente, mas também a promoção da saúde mental e da QdV das crianças/adolescentes e dos seus pais.
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Nobili V, Alisi A, Newton KP, Schwimmer JB. Comparison of the Phenotype and Approach to Pediatric vs Adult Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology 2016; 150:1798-810. [PMID: 27003600 PMCID: PMC4887388 DOI: 10.1053/j.gastro.2016.03.009] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/29/2016] [Accepted: 03/08/2016] [Indexed: 02/06/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is one of the main chronic noncommunicable diseases in Westernized societies; its worldwide prevalence has doubled during the last 20 years. NAFLD has serious health implications not only for adults, but also for children. However, pediatric NAFLD is not only an important global problem in itself, but it is likely to be associated with increases in comorbidities, such as metabolic syndrome and cardiovascular diseases. There are several differences between NAFLD in children and adults, and it is not clear whether the disease observed in children is the initial phase of a process that progresses with age. The increasing prevalence of pediatric NAFLD has serious implications for the future adult population requiring appropriate action. Studies of NAFLD progression, pathogenesis, and management should evaluate disease phenotypes in children and follow these over the patient's lifetime. We review the similarities and differences of NAFLD between children and adults.
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Affiliation(s)
- V Nobili
- Hepato-metabolic Disease Unit and Liver Research Unit, Bambino Gesù Children’s Hospital and IRCCS, Rome, Italy
| | - A Alisi
- Hepato-metabolic Disease Unit and Liver Research Unit, Bambino Gesù Children’s Hospital and IRCCS, Rome, Italy
| | - Kimberly P. Newton
- 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, San Diego, 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, San Diego, California,Liver Imaging Group, Department of Radiology, University of California, San Diego School of Medicine, San Diego, California
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Kohli R, Sunduram S, Mouzaki M, Ali S, Sathya P, Abrams S, Xanthakos SA, Vos M, Schwimmer JB. Pediatric Nonalcoholic Fatty Liver Disease: A Report from the Expert Committee on Nonalcoholic Fatty Liver Disease (ECON). J Pediatr 2016; 172:9-13. [PMID: 26749112 PMCID: PMC4846502 DOI: 10.1016/j.jpeds.2015.12.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 10/27/2015] [Accepted: 12/01/2015] [Indexed: 02/08/2023]
Affiliation(s)
- Rohit Kohli
- Steatohepatitis Center, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Shikha Sunduram
- Section of Gastroenterology, Hepatology and Nutrition, and the Digestive Health Institute, Children’s Hospital Colorado, CO, USA
| | - Marialena Mouzaki
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Sabina Ali
- Stanford Children’s Health, Stanford, CA, USA
| | - Pushpa Sathya
- Gastroenterology, Hepatology and Nutrition, Discipline of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St.John’s, NL, Canada
| | - Stephanie Abrams
- Children’s Gastroenterology, Memorial Care SG, Long Beach, CA, USA
| | - Stavra A. Xanthakos
- Steatohepatitis Center, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Miriam Vos
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey B. Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics University of California, San Diego; Department of Gastroenterology, Rady Children’s Hospital, San Diego, CA, USA
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Schwimmer JB. Clinical advances in pediatric nonalcoholic fatty liver disease. Hepatology 2016; 63:1718-25. [PMID: 27100147 PMCID: PMC4843821 DOI: 10.1002/hep.28441] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/30/2015] [Indexed: 12/12/2022]
Affiliation(s)
- 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, San Diego, California,Liver Imaging Group, Department of Radiology, University of
California, San Diego School of Medicine, San Diego, California
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Africa JA, Newton KP, Schwimmer JB. Lifestyle Interventions Including Nutrition, Exercise, and Supplements for Nonalcoholic Fatty Liver Disease in Children. Dig Dis Sci 2016; 61:1375-86. [PMID: 27041377 PMCID: PMC4848041 DOI: 10.1007/s10620-016-4126-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/06/2016] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease among children. Lifestyle interventions, such as diet and exercise, are frequently recommended. Children with NAFLD have a distinct physiology that is different from obesity alone and has the potential to influence lifestyle treatments. Studies of diet alone in the treatment of pediatric NAFLD have focused on sugar and carbohydrate, but did not indicate any one dietary approach that was superior to another. For children who are obese and have NAFLD, weight loss may have a beneficial effect regardless of the diet used. Exercise is widely believed to improve NAFLD because a sedentary lifestyle, poor aerobic fitness, and low muscle mass are all risk factors for NAFLD. However, there have been no randomized controlled trials of exercise as a treatment for children with NAFLD. Studies of the combination of diet and exercise suggest a potential for improvement in serum alanine aminotransferase activity and/or magnetic resonance imaging liver fat fraction with intervention. There is also enthusiasm for the use of dietary supplements; however, studies in children have shown inconsistent effects of vitamin E, fish oil, and probiotics. This review presents the available data from studies of lifestyle intervention and dietary supplements published to date and highlights challenges that must be addressed in order to advance the evidence base for the treatment of pediatric NAFLD.
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Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States. Childhood NAFLD is associated with hepatic and nonhepatic morbidity and mortality. Nonhepatic associations include cardiovascular, metabolic, pulmonary, and psychological disorders. Cardiovascular conditions observed in childhood include left ventricular dysfunction. Furthermore, childhood obesity is associated with greater odds of having hepatocellular carcinoma as an adult. Evidence suggests that NAFLD may begin in utero in children of diabetic mothers. Thus rigorous efforts for structured diagnosis and follow-up are a priority to better develop the understanding of outcomes in pediatric NAFLD.
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Tapper EB, Lai M. Weight loss results in significant improvements in quality of life for patients with nonalcoholic fatty liver disease: A prospective cohort study. Hepatology 2016; 63:1184-9. [PMID: 26698379 PMCID: PMC4805484 DOI: 10.1002/hep.28416] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 11/28/2015] [Accepted: 12/19/2015] [Indexed: 01/08/2023]
Abstract
UNLABELLED Nonalcoholic fatty liver disease (NAFLD) is highly prevalent and associated with decreased quality of life (QOL). The currently available treatment is weight loss through lifestyle modification. However, longitudinal QOL data are lacking on whether weight loss improves QOL. We prospectively enrolled 151 patients with NAFLD from 2009 to 2014. All patients received a liver biopsy, lifestyle assessment, blood tests, and QOL tools, including the Chronic Liver Disease Questionnaire (CLDQ), a validated health-related quality of life measurement. All patients were followed with a repeat CLDQ at 6 months. The cohort included 91 (60%) men, ages 51.5 ± 12.6 years, 46 (30%) of whom were diabetic. Thirty (21%) had advanced fibrosis or cirrhosis and 67 (47%) had a NAFLD Activity Score >4. Overall, 47 (31%) patients achieved at least a 5% reduction in weight. The cohort's median baseline total CLDQ value was 5.6 (interquartile range: 4.8-6.2). Those who achieved at least a 5% reduction in weight had a 0.45 (95% confidence interval [CI]: 0.24-0.66; P < 0.0001) point improvement in the total CLDQ, compared to 0.003 (95% CI: -0.12-0.12; P = 0.95) in those who did not. Nondiabetic patients with nonalcoholic steatohepatitis and without advanced fibrosis are most likely to achieve QOL benefits from weight loss. For every decrement in body mass index (BMI), there was a corresponding increase of 0.09 (95% CI: 0.03-0.16) points in the CLDQ scale (P = 0.005), adjusting for histology, diabetes, sex, age, and change in alanine aminotransferase level and change in FIB-4 index. A decrease by 5 points in BMI leads to a 10% adjusted improvement in QOL. CONCLUSION Patients with NAFLD can experience significant improvements in QOL that appear specific to weight loss and not biochemical improvements.
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Affiliation(s)
- Elliot B. Tapper
- Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Michelle Lai
- Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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An K, Jallo N, Menzies V, Kinser P, Robins JLW, Starkweather A. Integrative Review of Co-Occurring Symptoms Across Etiologies of Chronic Liver Disease and Implications for Symptom Management Research and Practice. J Nurs Scholarsh 2015; 47:310-7. [DOI: 10.1111/jnu.12146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Kyungeh An
- Gamma Omega , Associate Professor; Virginia Commonwealth University School of Nursing; Richmond VA USA
| | - Nancy Jallo
- Gamma Omega , Assistant Professor; Virginia Commonwealth University School of Nursing; Richmond VA USA
| | - Victoria Menzies
- Gamma Omega , Associate Professor; Virginia Commonwealth University School of Nursing; Richmond VA USA
| | - Patricia Kinser
- Gamma Omega , Assistant Professor; Virginia Commonwealth University School of Nursing; Richmond VA USA
| | - Jo Lynne W. Robins
- Gamma Omega , Assistant Professor; Virginia Commonwealth University School of Nursing; Richmond VA USA
| | - Angela Starkweather
- Gamma Omega , Associate Professor; Virginia Commonwealth University School of Nursing; Richmond VA USA
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Sanyal AJ, Friedman SL, McCullough AJ, Dimick L. Challenges and opportunities in drug and biomarker development for nonalcoholic steatohepatitis: findings and recommendations from an American Association for the Study of Liver Diseases-U.S. Food and Drug Administration Joint Workshop. Hepatology 2015; 61:1392-405. [PMID: 25557690 PMCID: PMC4900161 DOI: 10.1002/hep.27678] [Citation(s) in RCA: 254] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/17/2014] [Accepted: 12/21/2014] [Indexed: 12/13/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease (CLD) in North America. It is a growing contributor to the burden of CDL requiring liver transplantation. Cirrhosis is also associated with an increased risk of hepatocellular cancer, which may occur even in the absence of cirrhosis in subjects with nonalcoholic steatohepatitis (NASH), the histological form of NAFLD associated with increased liver-related mortality. The diagnosis of NASH currently requires a liver biopsy. There are also no U.S. Food and Drug Administration (FDA)-approved therapies for NASH. Therefore, there is a need to develop better diagnostic and therapeutic strategies for patients with NASH, targeting both those with early-stage disease as well as those with advanced liver fibrosis. There are unique challenges in the design of studies for these target populations. The long relatively asymptomatic time interval in the progression of NAFLD and NASH to cirrhosis and ultimately liver failure, along with gaps in knowledge regarding disease modifiers, combine to present significant challenges in trial design. Therefore, there is an urgent need to develop methods to identify the populations at particular risk of disease progression and validate endpoints that reflect meaningful changes in health status in this population. This article summarizes the discussion at a joint workshop held September 5 and 6, 2013 in Silver Spring, Maryland, sponsored by the FDA and the American Association for the Study of Liver Diseases to develop guidance on diagnostic and therapeutic modalities for NASH.
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Affiliation(s)
- Arun J. Sanyal
- Div. of Gastroenterology, Hepatology and Nutrition, Dept. of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Scott L. Friedman
- Div. of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Arthur J. McCullough
- Dept. of Gastroenterology and Pathobiology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Lara Dimick
- Food and Drug Administration, US Federal Government
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Prevalence and correlates of suspected nonalcoholic fatty liver disease in Chinese American children. J Clin Gastroenterol 2015; 49:345-9. [PMID: 24667593 DOI: 10.1097/mcg.0000000000000121] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
GOALS The aim of this study was to evaluate the prevalence and clinical correlates of nonalcoholic fatty liver disease (NAFLD) in children of Chinese immigrants. BACKGROUND NAFLD is increasing in prevalence and is frequently identified in children. High rates of NAFLD were found in adult Chinese immigrants. However, there are limited data regarding NAFLD in Chinese American children. STUDY Clinical and laboratory data were collected from 407 children, aged 6 to 18 years, who had routine office visits at a Chinatown medical practice. Children were classified as having suspected NAFLD if common causes of liver disease were excluded, alanine aminotransferase levels exceeded established thresholds (>22.1 IU/L for girls and >25.8 IU/L for boys), and elevated alanine aminotransferase levels were confirmed by repeat measurement. RESULTS 6.1% of Chinese American children had suspected NAFLD, including 33% of obese children. Seventeen percent of children were overweight, 14% were obese, and 52% had 25-hydroxy vitamin D levels <20 ng/mL. In univariable analysis, children with suspected NAFLD were more frequently male, had higher body mass index percentile and lipid levels, and lower vitamin D levels compared with children without evidence of NAFLD. In multivariable analysis, suspected NAFLD was associated with higher BMI percentile and lower vitamin D levels when adjusting for other factors. CONCLUSIONS Chinese American children with obesity are at high risk for NAFLD. They should be screened accordingly, including testing for metabolic disorders and low vitamin D levels. Early identification of NAFLD in childhood will allow for intervention with lifestyle modification, providing a means to reduce the prevalence of NAFLD in children and adults.
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Akpo EIH, Cerri K, Kleintjens J. Predicting the impact of adverse events and treatment duration on medical resource utilization-related costs in hepatitis C genotype 1 treatment-naïve patients receiving antiviral therapy. PHARMACOECONOMICS 2015; 33:409-422. [PMID: 25577042 PMCID: PMC4381112 DOI: 10.1007/s40273-014-0249-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Studies on medical resource utilization (MRU) and related costs are important for evaluating the potential patient management and cost-effectiveness implications of antiviral treatments for hepatitis C virus (HCV) infection. The objectives of this study were (i) to compare the MRU and related costs for two treatment approaches; (ii) to identify the main drivers of resource use and costs; and (iii) to assess the effects of various treatment regimen attributes on MRU-related costs in a UK clinical setting. METHODS The analysis used data collected alongside the simeprevir (SMV) phase III trials for treatment-naïve genotype 1 HCV-infected patients; these data covered outpatient consultations with specialists, emergency room visits and hospital admissions. Logistic regressions were constructed to estimate the predictors of resource utilization, and a two-part multivariable analysis model was used to determine the total costs of treatment in the UK. RESULTS Data on 731 patients receiving SMV plus pegylated interferon and ribavirin (SMV/PegIFN/R) or PegIFN/R were included in the analysis. While MRU was similar between the SMV and PegIFN/R groups, MRU-related costs were significantly lower in the SMV group than in the PegIFN/R group (P < 0.05). High body mass index (P < 0.05), severe fibrosis (P < 0.05), shortened treatment duration to 24 weeks (P < 0.05), and anaemia and rash during treatment (P < 0.001) were identified as predictors of hospitalization and outpatient visits and as drivers of total costs. Univariate sensitivity analyses suggested that shortened treatment duration and lower occurrence of rash lead to large cost savings. CONCLUSION This study identified both baseline and on-treatment antiviral therapy characteristics as drivers of MRU-related costs for HCV patients following antiviral therapy. The shortened treatment duration and reduction in rash due to treatment with SMV triple therapy lead to substantial non-drug cost savings, compared with PegIFN/R treatment. This suggests that there are potential patient management and cost-effectiveness implications associated with the choice of specific antiviral treatments.
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Loy JJ, Youn HA, Schwack B, Kurian M, Ren Fielding C, Fielding GA. Improvement in nonalcoholic fatty liver disease and metabolic syndrome in adolescents undergoing bariatric surgery. Surg Obes Relat Dis 2014; 11:442-9. [PMID: 25820083 DOI: 10.1016/j.soard.2014.11.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/10/2014] [Accepted: 11/11/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children. It is linked to obesity and the metabolic syndrome (MS), predisposing to future cirrhosis. The objective of this study was to demonstrate the effects that weight loss achieved with laparoscopic adjustable gastric band (LAGB) has on the metabolic parameters and NAFLD scores of obese adolescents with evidence of fatty liver disease. METHODS Adolescents undergoing LAGB were evaluated for NAFLD with evidence of fatty liver on preoperative sonogram, serum biochemistry, or both between 2005 and 2011. Primary endpoint was change in NAFLD scores after LAGB and secondary endpoint change in MS criteria. RESULTS Fifty-six out of 155 adolescents had evidence of fatty liver disease at presentation. The group consisted of 17 (30%) male and 39 (70%) females, mean age 16.1 years (range 14-17.8 yr). Preoperative body mass index (BMI) was 48.8 kg/m(2) (±7) dropping to 37.9 kg/m(2) (±8.3) at 12 months and 36.8 kg/m(2) (±8.2) at 24 months. Fifteen (27%) patients met the criteria for MS. When comparing 1-year postsurgery to presurgery, the NAFLD score decreased by an average of .68 (SD = 1.03, P<.01). The 2-year NAFLD score decreased by a mean of .38 (SD = .99, P = .01). The reoperation rate for band/port related complications was 10.7% at 2 years with no mortality. MS rates improved from 27% to 2% at 2 years (P< .01). CONCLUSIONS LAGB is a safe and effective operation for obese adolescents with NAFLD. There was significant improvement in NAFLD scores and resolution of MS.
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Affiliation(s)
- John J Loy
- NYU Langone Medical Center, Department of Bariatric Surgery, New York, New York.
| | - Heekoung A Youn
- NYU Langone Medical Center, Department of Bariatric Surgery, New York, New York
| | - Bradley Schwack
- NYU Langone Medical Center, Department of Bariatric Surgery, New York, New York
| | - Marina Kurian
- NYU Langone Medical Center, Department of Bariatric Surgery, New York, New York
| | | | - George A Fielding
- NYU Langone Medical Center, Department of Bariatric Surgery, New York, New York
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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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Iñiguez IR, Yap J, Mager DR. Parental perceptions regarding lifestyle interventions for obese children and adolescents with nonalcoholic fatty liver disease. Paediatr Child Health 2014; 19:e24-9. [PMID: 24855432 DOI: 10.1093/pch/19.5.e24] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) affects 30% of obese children globally. The main treatment for NAFLD is to promote gradual weight loss through lifestyle modification. Very little is known regarding parental perspectives about the barriers and facilitators that influence the ability to promote healthy lifestyle behaviours in children with NAFLD. OBJECTIVES To explore and describe parental perspectives regarding barriers to and facilitators of implementing lifestyle modification in children with NAFLD. METHODS A mixed-methods approach, including qualitative methodology (focus groups) and validated questionnaires (Lifestyle Behaviour Checklist), was used to assess parental perceptions regarding barriers to and facilitators of lifestyle change in parents of children with healthy body weights (control parents) and in parents of children with NAFLD (NAFLD parents). RESULTS NAFLD parents identified more problem behaviours related to food portion size and time spent in nonsedentary physical activity, and lower parental self-efficacy than parents of controls (P<0.05). Major barriers to lifestyle change cited by NAFLD parents were lack of time, self-motivation and role modelling of healthy lifestyle behaviours. In contrast, control parents used a variety of strategies to elicit healthy lifestyle behaviours in their children including positive role modelling, and inclusion of the child in food preparation and meal purchasing decisions, and perceived few barriers to promoting healthy lifestyles. Internet sources were the main form of nutrition information used by parents. CONCLUSIONS Lifestyle modification strategies focused on promoting increased parental self-efficacy and parental motivation to promote healthy lifestyle behaviour are important components in the treatment of obese children with NAFLD.
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Affiliation(s)
| | - Jason Yap
- Division of Pediatric Gastroenterology and Nutrition, Stollery Children's Hospital; ; Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Diana R Mager
- Department of Agricultural, Food and Nutritional Science, University of Alberta; ; Department of Pediatrics, University of Alberta, Edmonton, Alberta
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Nobili V, Cutrera R, Liccardo D, Pavone M, Devito R, Giorgio V, Verrillo E, Baviera G, Musso G. Obstructive sleep apnea syndrome affects liver histology and inflammatory cell activation in pediatric nonalcoholic fatty liver disease, regardless of obesity/insulin resistance. Am J Respir Crit Care Med 2014; 189:66-76. [PMID: 24256086 DOI: 10.1164/rccm.201307-1339oc] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Obstructive sleep apnea syndrome (OSAS) and nonalcoholic fatty liver disease (NAFLD) are frequently encountered in obese children. Whether OSAS and intermittent hypoxia are associated with liver injury in pediatric NAFLD is unknown. OBJECTIVES To assess the relationship of OSAS with liver injury in pediatric NAFLD. METHODS Sixty-five consecutive children with biopsy-proven NAFLD (age, mean ± SD, 11.7 ± 2.1 yr; 58% boys; body mass index z score, 1.93 ± 0.61) underwent a clinical-biochemical assessment and a standard polysomnography. Insulin sensitivity, circulating proinflammatory cytokines, markers of hepatocyte apoptosis (cytokeratin-18 fragments), and hepatic fibrogenesis (hyaluronic acid) were measured. Liver inflammatory infiltrate was characterized by immunohistochemistry for CD45, CD3, and CD163, surface markers of leukocytes, T cells, and activated macrophage/Kupffer cells, respectively. OSAS was defined by an apnea/hypopnea index (AHI) greater than or equal to 1 event/h, and severe OSAS was defined by an AHI greater than or equal to 5 events/h. MEASUREMENTS AND MAIN RESULTS Fifty-five percent of children with NAFLD had nonalcoholic steatohepatitis (NASH), and 34% had significant (stage F ≥ 2) fibrosis. OSAS affected 60% of children with NAFLD; the presence and severity of OSAS were associated with the presence of NASH (odds ratio, 4.89; 95% confidence interval, 3.08-5.98; P = 0.0001), significant fibrosis (odds ratio, 5.91; 95% confidence interval, 3.23-7.42; P = 0.0001), and NAFLD activity score (β, 0.347; P = 0.029), independently of body mass index, abdominal adiposity, metabolic syndrome, and insulin resistance. This relationship held also in nonobese children with NAFLD. The duration of hemoglobin desaturation (Sa(O2) < 90%) correlated with increased intrahepatic leukocytes and activated macrophages/Kupffer cells and with circulating markers of hepatocyte apoptosis and fibrogenesis. CONCLUSIONS In pediatric NAFLD, OSAS is associated with biochemical, immunohistochemical, and histological features of NASH and fibrosis. The impact of hypoxemia correction on liver disease severity warrants evaluation in future trials.
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Schwimmer JB, Newton KP, Awai HI, Choi LJ, Garcia MA, Ellis LL, Vanderwall K, Fontanesi J. Paediatric gastroenterology evaluation of overweight and obese children referred from primary care for suspected non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2013; 38:1267-77. [PMID: 24117728 PMCID: PMC3984047 DOI: 10.1111/apt.12518] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 09/06/2013] [Accepted: 09/13/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Screening overweight and obese children for non-alcoholic fatty liver disease (NAFLD) is recommended by paediatric and endocrinology societies. However, gastroenterology societies have called for more data before making a formal recommendation. AIM To determine whether the detection of suspected NAFLD in overweight and obese children through screening in primary care and referral to paediatric gastroenterology resulted in a correct diagnosis of NAFLD. METHODS Information generated in the clinical evaluation of 347 children identified with suspected NAFLD through screening in primary care and referral to paediatric gastroenterology was captured prospectively. Diagnostic outcomes were reported. The diagnostic performance of two times the upper limit of normal (ULN) for alanine aminotransferase (ALT) was assessed. RESULTS Non-alcoholic fatty liver disease was diagnosed in 55% of children identified by screening and referral. Liver disease other than NAFLD was present in 18% of those referred. Autoimmune hepatitis was the most common alternative diagnosis. Children with NAFLD had significantly (P < 0.05) higher screening ALT (98 ± 95) than children with liver disease other than NAFLD (86 ± 74). Advanced fibrosis was present in 11% of children. For the diagnosis of NAFLD, screening ALT two times the clinical ULN had a sensitivity of 57% and a specificity of 71%. CONCLUSIONS Screening of overweight and obese children in primary care for NAFLD with referral to paediatric gastroenterology has the potential to identify clinically relevant liver pathology. Consensus is needed on how to value the risk and rewards of screening and referral, to identify children with liver disease in the most appropriate manner.
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Affiliation(s)
- J B Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, San Diego School of Medicine, University of CaliforniaSan Diego, CA, USA,Department of Gastroenterology, Rady Children's Hospital San DiegoSan Diego, CA, USA,Liver Imaging Group, Department of Radiology, San Diego School of Medicine, University of CaliforniaSan Diego, CA, USA
| | - K P Newton
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, San Diego School of Medicine, University of CaliforniaSan Diego, CA, USA,Department of Gastroenterology, Rady Children's Hospital San DiegoSan Diego, CA, USA
| | - H I Awai
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, San Diego School of Medicine, University of CaliforniaSan Diego, CA, USA,Department of Gastroenterology, Rady Children's Hospital San DiegoSan Diego, CA, USA,Liver Imaging Group, Department of Radiology, San Diego School of Medicine, University of CaliforniaSan Diego, CA, USA
| | - L J Choi
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, San Diego School of Medicine, University of CaliforniaSan Diego, CA, USA,Department of Gastroenterology, Rady Children's Hospital San DiegoSan Diego, CA, USA
| | - M A Garcia
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, San Diego School of Medicine, University of CaliforniaSan Diego, CA, USA,Department of Gastroenterology, Rady Children's Hospital San DiegoSan Diego, CA, USA
| | - L L Ellis
- Department of Pathology, Rady Children's Hospital San DiegoSan Diego, CA, USA,Department of Pathology, San Diego School of Medicine, University of CaliforniaLa Jolla, CA, USA,Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac UniversityHamden, CT, USA
| | - K Vanderwall
- Department of Anesthesiology, Rady Children's Hospital San DiegoSan Diego, CA, USA
| | - J Fontanesi
- Division of General Internal Medicine, Department of Medicine, Center for Management Science in Health, San Diego School of Medicine, University of CaliforniaLa Jolla, CA, USA,Departments of Family and Preventive Medicine and Pediatrics, San Diego School of Medicine, University of CaliforniaLa Jolla, CA, USA
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Bozic MA, Subbarao G, Molleston JP. Pediatric Nonalcoholic Fatty Liver Disease. Nutr Clin Pract 2013; 28:448-58. [DOI: 10.1177/0884533613489153] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Molly A. Bozic
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Girish Subbarao
- Indiana University School of Medicine, Indianapolis, Indiana
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Houghton-Rahrig LD, Schutte DL, von Eye A, Fenton JI, Given BA, Hord NG. Exploration of a symptoms experience in people with obesity-related nonalcoholic fatty liver disease. Nurs Outlook 2013; 61:242-251.e2. [PMID: 23849554 DOI: 10.1016/j.outlook.2013.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/29/2013] [Accepted: 05/07/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent condition strongly associated with obesity that can result in premature death. Little is known about the symptoms experience in this progressive disease, preventing health care providers from intervening in the early stages. PURPOSE This study explicated symptoms in persons with NAFLD at higher risk of disease progression defined as the presence of one or two copies of the PNPLA3 (rs738409)-G allele. METHOD Guided by the Symptoms Experience Model, 42 persons older than 21 years of age with diagnosed NAFLD were recruited from Western Michigan specialty offices in this cross-sectional descriptive study design. The Memorial Symptom Assessment Scale was used to measure the symptoms experience. DISCUSSION Participants (97%) experienced 1 or more symptoms (average number of symptoms 12.02, standard deviation = 8.817). There was no statistically significant relationship between symptoms and the PNPLA3 (rs738409) variants. Significant predictors of mean frequency, severity, and distress of symptoms (the Total Memorial Symptom Scale) (F[15, 25] = 2.609, p = .016) were identified. CONCLUSION People with NAFLD experience an average of 12 symptoms.
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