COMMENTARY

Ongoing Trials Put Focus Back on Fatty Liver Disease

The Liver Meeting 2017: American Association for the Study of Liver Diseases (AASLD)

William F. Balistreri, MD

Disclosures

December 11, 2017

In This Article

Nonalcoholic Fatty Liver Disease (NAFLD) in Children

Because a subset of children with NAFLD may develop severe histologic disease in early adolescence, Xanthakos and colleagues[4] sought to determine factors related to histologic progression and outcome.

They analyzed data from 122 children with NAFLD enrolled in clinical trials from 2005 to 2015; paired liver biopsies were obtained at the entry and end of any trial. They selected those children (the control group from the treatment trials) who had received only standard lifestyle counseling and placebo.

At baseline, compared with adolescents, preadolescents had more bridging fibrosis (23% vs 5%, respectively) and borderline zone 1 NASH (57% vs 13%, respectively) but less definite NASH (15% vs 47%, respectively).

Over time, fibrosis improved in 34% and progressed in 23%, with no age or sex difference. None had cirrhosis at baseline or at follow-up. Borderline/definite NASH resolved in 29%. Progression to definite NASH occurred in 18% and was associated with higher ALT, AST, gamma-glutamyl transferase (GGT), total cholesterol, and low-density lipoprotein cholesterol levels at baseline and with an increasing body mass index (BMI) z-score over time. White race, worsening ALT, and GGT and glycated hemoglobin levels were associated with progression of fibrosis. In all, 28% had worsening in either fibrosis or NASH, while 7% had both.

Of note, type 2 diabetes developed in 8%, a surprisingly high incidence of 44 cases per 1000 person-years. Because histologic severity of NAFLD worsened in approximately 30% of children receiving standard lifestyle counseling over the interval assessed, these subjects warrant close follow-up, screening for type 2 diabetes, and more intensive intervention, particularly if their BMI, ALT, GGT, and glucose homeostasis worsen over time.

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