Fatty liver disease (NAFLD) in obese children has distinct characteristics different from those found in adults

Potentially life-threatening non-alcoholic fatty liver disease (NAFLD) in obese children has distinct characteristics, often different from those found in adults, according to a University of California, San Diego (UCSD) School of Medicine study led by Jeffrey Schwimmer, M.D., assistant professor of pediatrics.

Presented May 18, 2004 at the annual Digestive Disease Week meeting in New Orleans, the largest international gathering of gastroenterology and hepatology physicians, surgeons and researchers, the findings describe a new paradigm for diagnosis of this common condition found in obese children and offer the potential for improved care.

Between 1997 and 2003, the investigators identified 100 children ages 2 to 18 with biopsy-proven NAFLD. They found clearly different patterns and locations of liver scarring and inflammation in children as compared to that typically seen in adults. Focusing on the most severe form of NAFLD, called nonalcoholic steatohepatitis, or NASH, the researchers divided it into two types which they named Type 1 (the classic adult pattern) and Type 2 (a proposed pediatric pattern).

Specifically, the researchers found that Type 2 NASH was more than three times as common as Type 1 NASH in children. Advanced liver scarring and cirrhosis were seen only in children with Type 2 NASH. In addition, they found that boys were more likely than girls to have Type 2 NASH and less likely to have Type 1. Type 2 NASH was also more common in children of non-white race or Hispanic ethnicity.

Schwimmer, director of the Fatty Liver Clinic at Children’s Hospital in San Diego, noted that “many obese children will already have NAFLD without any symptoms. Our data suggest particular groups of children at risk for advanced disease. We believe that the different injury patterns in children suggests differences in causation and potentially treatment and outcome. Additionally, we speculate that Type 2 NASH may also occur in adults, and this needs to be look for.”

Digestive Disease Week, held May 15-20, is jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT).