An Obese Child With Fatty Liver and Abdominal Pain: The Gut/Liver Axis

Valerio Nobili, MD; Claudia Della Corte, MD; Laura Stronati, PhD; Salvatore Cucchiara, MD, PhD


January 13, 2016

In This Article


On the basis of clinical, laboratory, and ultrasound findings, hepatic steatosis (suspected nonalcoholic fatty liver disease [NAFLD]) associated with the metabolic syndrome was diagnosed, according to International Diabetes Foundation criteria[1] (Table 2).

Table 2. International Diabetes Foundation Criteria for Diagnosis of the Metabolic Syndrome

Variable Criteriaa
  Age 10-16 Years Age > 16 Years
Waist circumference ≥ 90th percentile, or adult cut-off if lower White population: ≥ 36 in
Triglycerides ≥ 150 mg/dL ≥ 150 mg/dL or on treatment for this lipid abnormality
HDL cholesterol < 40 mg/dL < 40 mg/dL in males and < 50 mg/dL in females, or on specific treatment for this lipid abnormality
Fasting glucose > 100 mg/dL > 100 mg/dL, or known type 2 diabetes mellitus
BP Systolic BP ≥ 130 mm Hg, or diastolic BP ≥ 85 mm Hg Systolic BP ≥ 130 mm Hg or diastolic BP ≥ 85 mm Hg, or treatment of previously diagnosed hypertension

BP = blood pressure; HDL = high-density lipoprotein
a For diagnosis of the metabolic syndrome, three of the five criteria must be present.

Although alarm symptoms and signs according to the Rome III criteria were not present, the Rome III diagnostic criteria for functional gastrointestinal disorder, subtype irritable bowel syndrome, were fulfilled[2] (Table 3).

Table 3. Rome III Diagnostic and Alarm Criteria for Irritable Bowel Syndrome

Diagnostic Criteriaa
Abdominal discomfort (an uncomfortable sensation not described as pain) or pain associated with two or more of the following, at least 25% of the time:
  • Improved with defecation

  • Onset associated with a change in frequency of stool

  • Onset associated with a change in form (appearance) of stool

No evidence of an inflammatory, anatomical, metabolic, or neoplastic process that explains the patient's symptoms
Alarm Symptoms and Signs in Children and Adolescents With FGDs
  • Persistent right upper- or right lower-quadrant pain

  • Pain that wakes the child from sleep

  • Dysphagia

  • Arthritis

  • Persistent vomiting

  • Perirectal disease

  • Gastrointestinal blood loss

  • Involuntary weight loss

  • Nocturnal diarrhea

  • Deceleration of linear growth

  • Family history of inflammatory bowel disease, celiac disease, or peptic ulcer disease

  • Delayed puberty

  • Unexplained fever

FGDs = functional gastrointestinal disorders
a All diagnostic criteria must be fulfilled.



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