Letter to the editor: Risk factors of NAFLD in preterm and low birthweight. More questions than answers!

Abstract

To the editor: We read with interest the article by Amadou et al. on the association between birth weight, preterm birth, and NAFLD in a community-based cohort. [1] The study showed that premature birth (OR = 1.23; 95% CI, 1.03-1.48 for birth between 33 and 37 vs. ≥ 37 weeks) was associated with NAFLD. This study is important given that knowing neonate risk factors would help clinicians in the management and elimination of the future risk of NAFLD. However, certain issues need consideration.First, because the study took the birth health card as the retrospective data in a selected group of patients, the investigators did not mention hospital admission and duration of hospital stay at birth. Prolonged hospital admission requires artificial feeding; whether neonates received formula feeding or breast milk was also not mentioned. Previous studies have shown that neonates who were exclusively breastfed had a lower risk of developing subsequent NAFLD. [2] Second, the study should also have discussed the weight chart in preterm, which is an important pillar of management, given that there is a tendency to overfeed at preterm, which predisposes neonates to "catch-up growth." Previous studies have shown that catch-up growth is one of the risk factors for developing obesity as well as the future risk of NAFLD in preterm patients. [3] Last, preterm neonates have an elevated risk of being born with other congenital, genetic, and metabolic disorders affecting multiple organs. The study by Amadou et al. indicates neither any genetic or metabolic risk factor nor the liver biopsy to rule out other metabolic disorders that may predispose neonates to NAFLD. [4] CONFLICT OF INTEREST Nothing to report.