The Association of Non-alcoholic Fatty Liver Disease Between Parents and Adolescent Children

Yewan Park; Dong Hyun Sinn; Kyunga Kim; Geum-Youn Gwak

Disclosures

Aliment Pharmacol Ther. 2023;57(2):245-252. 

In This Article

Abstract and Introduction

Abstract

Background: Data reporting the heritability of non-alcoholic fatty liver disease (NAFLD) are highly variable.

Aims: To investigate the association of NAFLD between parents and their adolescent children using a nationwide, population-based cohort.

Methods: We analysed 1737 families with both parents and adolescent children aged 12–18 who participated in Korean National Health and Nutrition Examination Surveys (KNHANES) between 2010 and 2019. NAFLD was defined by body mass index and elevated alanine aminotransferase levels in children and by the hepatic steatosis index in parents.

Results: The prevalence of NAFLD in adolescent children with either parent with NAFLD was higher than that in those without a parent with NAFLD (10.2% vs. 3.1%, p < 0.001). In a model fully adjusted for demographic, nutritional, behavioural and metabolic risk factors, children with either parent with NAFLD had a higher odds ratio (OR) for NAFLD (OR = 1.75, 95% CI: 1.02–3.00) than those without a parent with NAFLD. Compared to those without a parent with NAFLD, the fully adjusted ORs of NAFLD in children with paternal NAFLD, maternal NAFLD and NAFLD in both parents were 1.80 (95% CI: 1.01–3.20), 2.21 (95% CI: 1.11–4.42) and 2.60 (95% CI: 1.03–6.54), respectively.

Conclusion: Adolescent children with a parent with NAFLD were at increased risk of NAFLD; risk was higher when both parents had NAFLD. Further studies are needed to explore the benefit of NAFLD screening in children who have a parent with NAFLD.

Introduction

Non-alcoholic fatty liver disease (NAFLD) is characterised by lipid accumulation in the liver without genetic or metabolic disorders, heavy alcohol drinking, the use of steatogenic medications, or malnutrition.[1] NAFLD is the most common liver disease among children and adolescents with a prevalence of 9.6 to 11.2% of all children and 29% to 45% of obese children.[1–3] Paediatric NAFLD is associated with an increased risk of liver-related morbidity and mortality.[4] Thus, an effective screening strategy for children is needed to identify NAFLD patients early, prior to the onset of irreversible, end-stage liver diseases.[3]

Genetic predisposition is known to affect the risk of NAFLD development.[5] NAFLD family clustering has been reported,[6,7] suggesting that children with a family history of NAFLD are at an increased risk of developing NAFLD. Indeed, the North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) recommends NAFLD screening beginning between the ages of 9 and 11 years for all obese children and overweight children with additional risk factors, such as a family history of NAFLD.[3] However, due to insufficient evidence, the European Association for the Study of the Liver, the European Association for the Study of Diabetes, and the European Association for the Study of Obesity (EASL-EASD-EASO) and the American Association for the Study of Liver Diseases (AASLD) do not recommend screening for NAFLD in children based on body weight and family history.[8,9]

Several family studies have suggested that NAFLD may be passed down over generations.[6,10–13] However, data reporting the heritability of NAFLD are highly variable, ranging from no heritability to nearly universal heritability. In addition, the benefit of NAFLD screening for family members is uncertain. To date, the NAFLD risk in children in relation to their parents' NAFLD status were largely unexplored in a population-based study. In this study, we investigated the association of NAFLD between parents and their adolescent children, using a nationwide, population-based cohort.

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