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J Pediatr. 2003 Oct;143(4):500-5.

Obesity, insulin resistance, and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease.

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  • 1Joint Program in Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Family and Preventive Medicine, Department of Pathology, the School of Medicine, University of California-San Diego, 200 West Arbor Drive, San Diego, CA 92103, USA.

Abstract

OBJECTIVE:

To describe the clinical characteristics of nonalcoholic fatty liver disease (NAFLD) in children, including insulin resistance, and to test for correlation with liver pathology.

STUDY DESIGN:

A retrospective review of children with biopsy-proven NAFLD at Children's Hospital San Diego from 1999 to 2002. Liver biopsy specimens were independently reviewed by two pathologists.

RESULTS:

Children with NAFLD (n=43) were mostly male (70%), Hispanic American (53%) and obese (88%). The criteria for insulin resistance were met by 95% of subjects. Steatosis was predicted by the combination of quantitative insulin sensitivity check index, age, and ethnicity (P<.0001). Portal inflammation was predicted by the combination of ALT and fasting insulin (P=.0009). Perisinusoidal fibrosis was predicted by the combination of AST, fasting insulin, and BMI Z score (P<.0001). Portal fibrosis was predicted by the combination of right upper quadrant pain and homeostasis model assessment of insulin resistance (P=.0028).

CONCLUSIONS:

We identified significant predictors of liver pathology in children with NAFLD. Children being evaluated for NAFLD should be screened for insulin resistance, which is nearly universal and correlates with liver histology.

[PubMed - indexed for MEDLINE]
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