Portal de Periódicos da CAPES

In Children With Nonalcoholic Fatty Liver Disease, Zone 1 Steatosis Is Associated With Advanced Fibrosis

2017; Elsevier BV; Volume: 16; Issue: 3 Linguagem: Inglês

10.1016/j.cgh.2017.02.030

1542-7714

Jonathan A. Africa, Cynthia Behling, Elizabeth M. Brunt, Nan Zhang, Yunjun Luo, Alan Wells, Jiayi Hou, Patricia Belt, Rohit Kohil, Joel E. Lavine, Jean P. Molleston, Kimberly P. Newton, Peter F. Whitington, Jeffrey B. Schwimmer, Stephanie H. Abrams, Sarah E. Barlow, Ryan Himes, Rajesh Krisnamurthy, Leanel Maldonado, Rory Mahabir, April Carr, Kimberlee Bernstein, Kristin Bramlage, Kim M. Cecil, Stephanie DeVore, Rohit Kohli, Kathleen D. Lake, Daniel J. Podberesky, Alexander J. Towbin, Stavra A. Xanthakos, Gerald Behr, Joel E. Lavine, Jay H. Lefkowitch, Ali Mencin, Elena Reynoso, Adina Alazraki, Rebecca Cleeton, María Cordero, Albert Hernández, Saul J. Karpen, Jessica Cruz Muños, Nicholas Raviele, Miriam B. Vos, Molly Bozic, Oscar W. Cummings, Ann Klipsch, Jean P. Molleston, Emily Ragozzino, Kumar Sandrasegaran, Girish Subbarao, Laura Walker, Kimberly Kafka, Ann Scheimann, Joy Ito, Mark Fishbein, Saeed Mohammad, Cynthia K. Rigsby, Lisa Sharda, Peter F. Whitington, Sarah E. Barlow, Theresa Cattoor, Jose Derdoy, Janet Freebersyser, Ajay K. Jain, Debra King, Jinping Lai, Pat Osmack, Joan Siegner, Susan D. Stewart, Susan Torretta, Kristina Wriston, Susan S. Baker, Diana Lopez–Graham, Sonja D. Williams, Lixin Zhu, Jonathan A. Africa, Hannah I. Awai, Cynthia Behling, Craig Bross, Jennifer Collins, Janis Durelle, Kathryn E. Harlow, Michael S. Middleton, Kimberly P. Newton, Melissa Paiz, Jeffrey B. Schwimmer, Claude B. Sirlin, Patricia Ugalde‐Nicalo, Mariana Dominguez Villarreal, Bradley E. Aouizerat, Jesse Courtier, Linda D. Ferrell, Natasha A. Feier, Ryan M. Gill, Camille Langlois, Emily R. Perito, Philip Rosenthal, Patrika Tsai, Kara Cooper, Simon Horslen, Evelyn Hsu, Karen F. Murray, Randolph K. Otto, Matthew M. Yeh, Melissa Young, Elizabeth M. Brunt, Kathryn J. Fowler,

Liver Diseases and Immunity

Background & AimsFocal zone 1 steatosis, although rare in adults with nonalcoholic fatty liver disease (NAFLD), does occur in children with NAFLD. We investigated whether focal zone 1 steatosis and focal zone 3 steatosis are distinct subphenotypes of pediatric NAFLD. We aimed to determine associations between the zonality of steatosis and demographic, clinical, and histologic features in children with NAFLD.MethodsWe performed a cross-sectional study of baseline data from 813 children (age <18 years; mean age, 12.8 ± 2.7 years). The subjects had biopsy-proven NAFLD and were enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network. Liver histology was reviewed using the Nonalcoholic Steatohepatitis Clinical Research Network scoring system.ResultsZone 1 steatosis was present in 18% of children with NAFLD (n = 146) and zone 3 steatosis was present in 32% (n = 244). Children with zone 1 steatosis were significantly younger (10 vs 14 years; P < .001) and a significantly higher proportion had any fibrosis (81% vs 51%; P < .001) or advanced fibrosis (13% vs 5%; P < .001) compared with children with zone 3 steatosis. In contrast, children with zone 3 steatosis were significantly more likely to have steatohepatitis (30% vs 6% in children with zone 1 steatosis; P < .001).ConclusionsChildren with zone 1 or zone 3 distribution of steatosis have an important subphenotype of pediatric NAFLD. Children with zone 1 steatosis are more likely to have advanced fibrosis and children with zone 3 steatosis are more likely to have steatohepatitis. To achieve a comprehensive understanding of pediatric NAFLD, studies of pathophysiology, natural history, and response to treatment should account for the zonality of steatosis.