A natural history study of paediatric non-alcoholic fatty liver disease over 10 years

Draijer, Laura G.; Voorhoeve, Maaike; Troelstra, Marian; Holleboom, Adriaan G.; Beuers, Ulrich; Kusters, Meeike; Nederveen, Aart J.; Benninga, Marc A.; Koot, Bart

doi:10.1016/j.jhepr.2023.100685

Cited by 12 publications

(4 citation statements)

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“…This is concerning, as implementation of lifestyle changes is challenging, and natural history data suggest that pediatric onset MASLD can be associated with significant morbidity and mortality later in life. [7][8][9][10][11] As such, determination of MASLD risk factors which can be targeted to prevent disease development and progression is crucial.…”

Section: Introductionmentioning

confidence: 99%

Gestational and Developmental Contributors of Pediatric MASLD

Mouzaki,

Woo,

Divanovic

2024

Semin Liver Dis

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Pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) is common and can be seen as early as in utero. A growing body of literature suggests that gestational and early life exposures modify the risk of MASLD development in children. These include maternal risk factors, such as poor cardiometabolic health (e.g., obesity, gestational diabetes, rapid weight gain during pregnancy, and MASLD), as well as periconceptional dietary exposures, degree of physical activity, intestinal microbiome, and smoking. Paternal factors, such as diet and obesity, also appear to play a role. Beyond gestation, early life dietary exposures, as well as the rate of infant weight gain, may further modify the risk of future MASLD development. The mechanisms linking parental health and environmental exposures to pediatric MASLD are complex and not entirely understood. In conclusion, investigating gestational and developmental contributors to MASLD is critical and may identify future interventional targets for disease prevention.

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Section: Introductionmentioning

confidence: 99%

Gestational and Developmental Contributors of Pediatric MASLD

Mouzaki,

Woo,

Divanovic

2024

Semin Liver Dis

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“…6 In a recent longitudinal study, 6% of children with NAFLD progressed to advanced fibrosis within a 10-year timespan. 7 This can lead to the development of cirrhosis and the need for liver transplantation in young adulthood, several decades earlier than in the paradigmatic case of adult-onset NAFLD. [8][9][10][11] Liver biopsy represents the reference standard for the quantification of fibrosis, especially with regard to zonal differences in collagen deposition.…”

Section: Introductionmentioning

confidence: 99%

“…NASH‐associated inflammatory activity results in hepatocyte injury and the onset of wound healing responses promoting liver fibrosis 6 . In a recent longitudinal study, 6% of children with NAFLD progressed to advanced fibrosis within a 10‐year timespan 7 . This can lead to the development of cirrhosis and the need for liver transplantation in young adulthood, several decades earlier than in the paradigmatic case of adult‐onset NAFLD 8–11 …”

Section: Introductionmentioning

confidence: 99%

Noninvasive scores are poorly predictive of histological fibrosis in paediatric fatty liver disease

Kalveram,

Baumann,

De Bruyne

et al. 2023

J. pediatr. gastroenterol. nutr.

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ObjectivesNonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children. Roughly a quarter of pediatric patients with NAFLD develop nonalcoholic steatohepatitis and fibrosis. Here, we evaluated the diagnostic accuracy of previously published noninvasive fibrosis scores to predict liver fibrosis in a large European cohort of pediatric patients with NAFLD.MethodsThe 457 patients with biopsy‐proven NAFLD from 10 specialized centers were included. We assessed diagnostic accuracy for the prediction of any (F ≥ 1), moderate (F ≥ 2) or advanced (F ≥ 3) fibrosis for the AST/platelet ratio (APRI), Fibrosis 4 score (FIB‐4), pediatric NAFLD fibrosis score (PNFS) and pediatric NAFLD fibrosis index (PNFI).ResultsPatients covered the full spectrum of fibrosis (F0: n = 103; F1: n = 230; F2: n = 78; F3: n = 44; F4: n = 2). None of the scores were able to accurately distinguish the presence of any fibrosis from no fibrosis. For the detection of moderate fibrosis, area under the receiver operating characteristic curve (AUROC) were: APRI: 0.697, FIB‐4: 0.663, PNFI: 0.515, PNFS: 0.665, while for detection of advanced fibrosis AUROCs were: APRI: 0.759, FIB‐4: 0.611, PNFI: 0.521, PNFS: 0.712. Fibrosis scores showed no diagnostic benefit over using ALT ≤ 50/ > 50 IU/L as a cut‐off.ConclusionsEstablished fibrosis scores lack diagnostic accuracy to replace liver biopsy for staging of fibrosis, giving similar results as compared to using ALT alone. New diagnostic tools are needed for Noninvasive risk‐stratification in pediatric NAFLD.

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“…A recent meta‐analysis from India reported the estimated pooled prevalence to be 38.6% in adults and alarmingly 35.4% in children 22 . As reported by Draijer et al ., only one‐third of children with pediatric NAFLD have a resolution of steatosis as adults, while 6% develop NAFLD‐related fibrosis 23 . These two results highlight the need for increased inclusivity and representation of a South East Asian cohort in studies pertaining to NAFLD.…”

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confidence: 99%