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O0115 FATTY LIVER DISEASE IN CHILDREN IN THE WEST MIDLANDS, UNITED KINGDOM

2004; Lippincott Williams & Wilkins; Volume: 39; Issue: Supplement 1 Linguagem: Inglês

10.1097/00005176-200406001-00117

1536-4801

Helen Evans, Ulrich Baumann, P. J. McKiernan, Jeremy Kirk, Guftar Shaikh, D. Kelly,

Diet and metabolism studies

Introduction: The incidence of non-alcoholic fatty liver disease is increasing worldwide in adults and children and may be related to the global epidemic of obesity. The more severe form non-alcoholic steatohepatitis, (NASH) can progress to end stage liver disease in adults, but little is known about outcome in children. Aim: To describe the demographic, biochemical and histo-logical features of children with fatty liver referred to a national Liver Unit. Methods: All children (n = 38; 21 male; median age 13.1 yrs) referred with fatty liver between Jan 2000 – Oct 2003 underwent investigation to exclude other liver diseases and to identify insulin resistance using the Homeostasis Model Assessment (HOMA) method and C-peptide. All had abdominal ultrasonography (USS) and also liver biopsy if raised ALT (> 1.5 times normal) after 6 months of diet and increased exercise. Results: Median body mass index z-score was +3.0 (−3.9 to +4.5) with 30/38 being obese (BMI z-score > 2.0). 1 had Type 2 diabetes, 17 had insulin resistance by HOMA and 11 had raised C-peptide suggesting insulin overproduction. 24 had raised tri-glycerides, 11 had autoantibodies and 17 had low T4 and/or raised TSH. 36 had a USS suggesting fatty liver. 27/30 who underwent liver biopsy had fatty liver, (including 2 with normal USS). Of these, 10 had NASH and 3 had cirrhosis. 2 biopsies were normal (despite abnormal USS) and 1 had glycogen storage disorder. There was no correlation between the severity of fatty liver on biopsy and ALT, insulin resistance or triglycerides. Conclusion: Fatty liver disease is a major health concern in British children. Most are obese and insulin resistance is common. USS is a non-invasive method of evaluation but is not sensitive nor specific and liver biopsy is the only method to diagnose NASH. Further evaluation of the role of autoantibodies and thyroid dysfunction is required.