Epidemiology

Severe fatty liver disease common in obese children

Last Updated: 2004-05-18 16:00:20 -0400 (Reuters Health)

By Karla Gale

NEW ORLEANS (Reuters Health) - Children with nonalcoholic fatty steatohepatitis (NASH) are at high risk of severe liver disease, according to data presented by Dr. Jeffrey Schwimmer here at Digestive Disease Week.

NASH is the most common severe liver disease in obese children, Dr. Schwimmer said during his presentation. "It is incredibly prevalent, present in more than one million children in the US. About 25% go on to develop cirrhosis," and they are at risk for cirrhosis, liver failure and liver cancer, he added.

The histological characteristics of pediatric nonalcoholic fatty liver disease are quite different from that in adults. Historically, pediatric NASH has been called type 2, and adult type called type 1.

Type 1 NASH is defined as "steatosis with ballooning degeneration and/or perisinusoidal fibrosis with or without portal inflammation or fibrosis," according to his group's meeting abstract. "Type 2 NASH was defined as steatosis with portal inflammation and/or fibrosis without perisinusoidal fibrosis or lobular inflammation."

However, when Dr. Schwimmer, of the University of California, San Diego, and his group examined biopsies from 100 children with fatty liver disease, 98 of whom were overweight or obese, they saw that 41 had type 2 NASH and 12 had type 1. The seven patients with advanced fibrosis or cirrhosis were all type 2 NASH.

Those with type 2 NASH had greater severity of obesity than type 1 and were more likely to be boys.

And "there was a tremendous difference in racial and ethnic distribution," Dr. Schwimmer added. "The vast majority of those with type 2 were Hispanic."

These findings suggest that the etiology differs between type 1 and type 2, he suggested.

"We need to increase awareness, because few people realize that obese children are at great risk for liver disease," he said.

The National Institutes of Health has established a clinical research network to study NASH, with the expectation that treatment trials will start later this year, he said.

Digestive Disease Week is jointly sponsored by the American Association for the Study of Liver Diseases, the American Gastroenterological Association, the American Society for gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract.