Hepatic Steatosis Is Highly Prevalent Across the Paediatric Age Spectrum, Including in Pre-school Age Children

J. Dhaliwal; G. B. Chavhan; E. Lurz; A. Shalabi; N. Yuen; B. Williams; I. Martincevic; A. Amirabadi; P. W. Wales; W. Lee; S. C. Ling; M. Mouzaki

Disclosures

Aliment Pharmacol Ther. 2018;48(5):556-563. 

In This Article

Results

Of the 813 subjects found in the Trauma Database from 2004 to 2015, 503 (51% male) met the inclusion criteria, the majority of the exclusions were due to hepatic and/or splenic injury. The mean (±SD) age of the cohort was 9.5 ± 4.5 years and was similar between males and females. The mean weight z-score was 0.37 ± 1.05 (males: 0.39 ± 1.04, females: 0.35 ± 1.07, P = 0.4). The median weight (kg) (IQR) was 30 kg (20–52) (males:32 kg [20–54], females:30 kg [20–51], P = 0.70) A total of 27(5%) subjects had a weight z-score ≥2. Height data were available only for 26(5%) patients and analyses of BMI or weight-for-height could therefore not be undertaken for the group.

Hepatic Steatosis

In our cohort, 77 (15%, 95% CI [12%–18%]) subjects (42% male) had imaging evidence of hepatic steatosis. The proportion of patients with hepatic steatosis was not different between males and females (12.4% vs 18%, respectively; P = 0.07) or across different age groups (P = 0.84). Table 1 summarizes the distribution of children with hepatic steatosis across different age quartiles.

Abdominal Adipose Tissue Measurements

The median (IQR) abdominal subcutaneous adipose tissue measurement in our cohort was 6.4 mm (3.6–13.7). It was greater in females than in males (9.0 mm [4.7–20.2] vs 5.0 mm [3.1–8.3], P < 0.001, respectively). Abdominal subcutaneous adipose measurements (mm) correlated with abdominal subcutaneous area, r = .83. The median (IQR) abdominal subcutaneous adipose tissue area was 26.0% (17.9–36.4). Female subjects had greater abdominal subcutaneous adipose tissue area compared to males (31.8% [22.5–42.3] vs 20.8% [14.8–29.6], P < 0.001, respectively) and this was consistent across the age strata. The median (IQR) visceral adipose tissue area was 7.1% (5.3–8.8). There was no difference in abdominal visceral adipose tissue between females and males (7.3% [5.5–9.1] and 6.9% [5.1–8.6], P = 0.13). The differences in abdominal adiposity of those with and without steatosis for the entire cohort and also for those younger and older than the median age (9.8 years) are shown in Table 2. The proportion of children with hepatic steatosis increased as the per cent of abdominal subcutaneous adiposity increased (Figure 3). The proportion of children with hepatic steatosis increased as the per cent of abdominal visceral adiposity increased (Figure 4).

Figure 3.

Proportion of subjects with hepatic steatosis with increasing abdominal subcutaneous adipose tissue

Figure 4.

Proportion of subjects with hepatic steatosis with increasing visceral adipose tissue

Alanine Aminotransferase (ALT) and Hepatic Steatosis

The median (IQR) ALT of male subjects with hepatic steatosis was 42 U/L (28–72), and of female subjects was 40 U/L (28–55). The majority (84% of males and 92% of females) of children with hepatic steatosis had an elevated ALT (>26 and >22 U/L, respectively). ALT values twice the upper limit of normal had a sensitivity of 40% and a specificity of 85% for hepatic steatosis (Table 3).

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....