Non-alcoholic fatty liver disease in obese and overweight children
Keywords:Obesity, NAFLD, ALT, Children
Background: Childhood obesity is rising alarmingly and approaching an epidemic proportion in many countries. It increases the risk of developing non-communicable disease in adulthood. Non-alcoholic fatty liver disease (NAFLD) is a key co-morbidity associated with obesity and emerged as the leading cause of chronic liver disease in children. This study aimed to see the prevalence of the NAFLD with overweight and obesity among children.
Methods: It was a cross sectional study conducted among children aged 5.5 to 18 years attending in the pediatric endocrinology clinic of department of pediatrics, Bangabandhu Sheikh Mujib medical university over a period of 14 months. Children’s weight and height were evaluated and then BMI was calculated for particular age and sex according to center for disease control growth chart. All obese and overweight children were included except those taking systemic steroid, or suffering from genetic, endocrine, liver or renal disease. Patients were advised to do serum alanine aminotransferase (ALT) and ultrasonography of hepatobiliary system.
Results: A total of 90 children were enrolled in the study. Among them majority (93.3%) were obese and the rest were overweight (6.7%). Overall, 40% children had NAFLD including 40.5% among the obese and 33.3% among the overweight (p>0.05). Majority (91.6%) had mild NAFLD. Alanine amino transferase (ALT) level was raised significantly among children with NAFLD compared to those without NAFLD (58.3% and 16.7% respectively, p<0.001).
Conclusions: More than one-third of the overweight and obese children had NAFLD with a significantly higher level of ALT compared to children without NAFLD. Therefore, NAFLD should be routinely screened among children with increased weight to take timely intervention and prevent further progression of the disease.
Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes. 2006;1(1):11-25.
Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766-81.
Gupta N, Goel K, Shah P, Misra A. Childhood obesity in developing countries: Epidemiology, determinants, and prevention. Endocr Rev. 2012;33(1):48-70.
Bulbul T, Hoque M. Prevalence of childhood obesity and overweight in Bangladesh: findings from a countrywide epidemiological study. BMC Pediatr. 2014;14(1):86.
Goran MI, Rahman M, Reza S, Islam M, Rahman A, Nath A et al. Metabolic precursors and effects of obesity in children: a decade of progress, 1990-1999. Am J Clin Nutr. 2001;73(2):158-71.
Bellentani S, Marino M. Epidemiology and natural history of non-alcoholic fatty liver disease (NAFLD). Ann Hepatol. 2009;8(1):S4-8.
Benedict M, Zhang X. Non-alcoholic fatty liver disease: An expanded review. World J Hepatol. 2017;9(16):715.
Alisi A, Feldstein AE, Villani A, Raponi M, Nobili V. Pediatric nonalcoholic fatty liver disease: A multidisciplinary approach. Nat Rev Gastroenterol Hepatol. 2012;9(3):152-61.
Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of Fatty Liver in Children and Adolescents. Pediatrics. 2006;118(4):1388-93.
Giorgio V, Prono F, Graziano F, Nobili V. Pediatric non alcoholic fatty liver disease: old and new concepts on development, progression, metabolic insight and potential treatment targets. BMC Pediatr. 2013;13(1):40.
Day CP, James OFW. Steatohepatitis: A tale of two “hits”? Gastroenterology. 1998;114(4):842-5.
Shelim R, Mohsin F, Begum T, Baki M, Mahbuba S, Islam R. Hepatic Steatosis among Obese Children and Adolescents. J Bangladesh Coll Physicians Surg. 2017;34(2):57-63.
Chan DFY, Li AM, Chu WCW, Chan MHM, Wong EMC, Liu EKH et al. Hepatic steatosis in obese Chinese children. Int J Obes. 2004;28(10):1257-63.
Fu JF, Shi HB, Liu LR, Jiang P, Wang CL, Liu XY. Non-alcoholic fatty liver disease: An early mediator predicting metabolic syndrome in obese children? World J Gastroenterol. 2011;17(6):735.
Pawar SV, Zanwar VG, Choksey AS, Mohite AR, Jain SS, Surude RG, et al. Most overweight and obese Indian children have nonalcoholic fatty liver disease. Ann Hepatol. 15(6):853-61.
Rong Y, Chun-Yan N, Hong-Xin Z, Lu Y, Wen W, Yu T. Association of Adolescent Obesity with Nonalcoholic Fatty Liver Disease and Related Risk Factors in Xi ’an, China. Ann Hepatol. 2018;17(1):85-91.
Rafeey mandana, Mogaddasi, Hasani, Ghaffari. Fatty liver in children. Ther Clin Risk Manag. 2009;371.
Younossi ZM, Stepanova M, Afendy M, Fang Y, Younossi Y, Mir H, et al. Changes in the Prevalence of the Most Common Causes of Chronic Liver Diseases in the United States From 1988 to 2008. Clin Gastroenterol Hepatol. 2011;9(6):524-530.e1.