Clinical

Abdominal obesity linked to liver fibrosis in pediatric non-alcoholic steatohepatitis

Last Updated: 2008-09-15 16:15:36 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Abdominal obesity contributes to liver fibrosis in children with non-alcoholic fatty liver disease, according to findings published in the September issue of the journal Gut.

"Waist circumference is widely accepted as a risk factor for cardiovascular disease and metabolic syndrome," Dr. Valerio Nobili, of Pediatric Hospital "Bambino Gesu," Rome, Italy, and colleagues write. "A contribution of metabolic syndrome, and especially of waist circumference, to liver fibrosis in children with NAFLD is strongly suspected."

To investigate, the researchers enrolled 197 consecutive Caucasian children with NAFLD in a cross-sectional study. The team assessed the contribution of age, gender, body mass index (BMI) and components of metabolic syndrome, including waist circumference, high-density lipoprotein cholesterol, triglycerides, blood pressure and glucose, to the odds of liver fibrosis in this population.

Dr. Nobili and colleagues found that 54 children (27%) were overweight and 128 (65%) were obese. Overall, 84% of children had a large waist (90th percentile or higher), 50% had low high-density lipoprotein cholesterol, 13% had hypertriglyceridemia, 13% had hypertension, and 5% had impaired fasting glucose or diabetes. Overall, 10% of the patients had metabolic syndrome. Fibrosis, which was mild in most cases, was observed in 67% of the children.

Results of multivariable analysis showed that a large waist was the only component of metabolic syndrome that was associated with liver fibrosis.

The investigators note that the prevalence of obesity and its associated complications is increasing in childhood. "The observed association with NAFLD makes it essential for health care providers to pay attention to preventing, diagnosing and treating fatty liver disease at an early age," Dr. Nobili and colleagues advise.

"Similarly to adults, the assessment of abdominal fat may represent a valuable tool for identifying those children with NAFLD who have liver fibrosis," they note. "The rationale for using waist circumference in clinical practice is that it is a surrogate measure of abdominal fat and, most important, a predictor of early and late cardiometabolic complications of childhood obesity."

Gut 2008;57:1283-1287.