The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years
Objectives:The long-term prognosis of non-alcoholic fatty liver disease (NAFLD) in children remains uncertain. We aimed at determining the long-term outcomes and survival of children with NAFLD.Design:Retrospective longitudinal hospital-based cohort study.Patients:Sixty-six children with NAFLD (mean...
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| Veröffentlicht in: | Gut 2009-11, Vol.58 (11), p.1538-1544 |
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| creator | Feldstein, A E Charatcharoenwitthaya, P Treeprasertsuk, S Benson, J T Enders, F B Angulo, P |
| description | Objectives:The long-term prognosis of non-alcoholic fatty liver disease (NAFLD) in children remains uncertain. We aimed at determining the long-term outcomes and survival of children with NAFLD.Design:Retrospective longitudinal hospital-based cohort study.Patients:Sixty-six children with NAFLD (mean age 13.9 (SD 3.9) years) were followed up for up to 20 years with a total of 409.6 person-years of follow-up.Results:The metabolic syndrome was present in 19 (29%) children at the time of NAFLD diagnosis with 55 (83%) presenting with at least one feature of the metabolic syndrome including obesity, hypertension, dyslipidaemia and/or hyperglycaemia. Four children with baseline normal fasting glucose developed type 2 diabetes 4–11 years after NAFLD diagnosis. A total of 13 liver biopsies were obtained from five patients over a mean of 41.4 (SD 28.8) months showing progression of fibrosis stage in four children. During follow-up, two children died and two underwent liver transplantation for decompensated cirrhosis. The observed survival free of liver transplantation was significantly shorter in the NAFLD cohort as compared to the expected survival in the general United States population of the same age and sex (log-rank test, p |
| doi_str_mv | 10.1136/gut.2008.171280 |
| format | Article |
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We aimed at determining the long-term outcomes and survival of children with NAFLD.Design:Retrospective longitudinal hospital-based cohort study.Patients:Sixty-six children with NAFLD (mean age 13.9 (SD 3.9) years) were followed up for up to 20 years with a total of 409.6 person-years of follow-up.Results:The metabolic syndrome was present in 19 (29%) children at the time of NAFLD diagnosis with 55 (83%) presenting with at least one feature of the metabolic syndrome including obesity, hypertension, dyslipidaemia and/or hyperglycaemia. Four children with baseline normal fasting glucose developed type 2 diabetes 4–11 years after NAFLD diagnosis. A total of 13 liver biopsies were obtained from five patients over a mean of 41.4 (SD 28.8) months showing progression of fibrosis stage in four children. During follow-up, two children died and two underwent liver transplantation for decompensated cirrhosis. The observed survival free of liver transplantation was significantly shorter in the NAFLD cohort as compared to the expected survival in the general United States population of the same age and sex (log-rank test, p<0.00001), with a standardised mortality ratio of 13.6 (95% confidence interval, 3.8 to 34.8). NAFLD recurred in the allograft in the two cases transplanted, with one patient progressing to cirrhosis and requiring re-transplantation.Conclusions:Children with NAFLD may develop end-stage liver disease with the consequent need for liver transplantation. NAFLD in children seen in a tertiary care centre may be associated with a significantly shorter survival as compared to the general population.</description><identifier>ISSN: 0017-5749</identifier><identifier>EISSN: 1468-3288</identifier><identifier>DOI: 10.1136/gut.2008.171280</identifier><identifier>PMID: 19625277</identifier><identifier>CODEN: GUTTAK</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher><subject>Adolescent ; Age ; Biological and medical sciences ; Biopsy ; Body mass index ; Child ; Child, Preschool ; Cholesterol ; Diabetes ; Diabetes Mellitus, Type 2 - diagnosis ; Diabetes Mellitus, Type 2 - etiology ; Early Diagnosis ; Epidemiologic Methods ; Family medical history ; Fasting ; Fatty Liver - mortality ; Fatty Liver - pathology ; Fatty Liver - surgery ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; Hepatitis ; Hospitals ; Humans ; Infant ; Insulin ; Insulin resistance ; Laboratories ; Liver - pathology ; Liver cirrhosis ; Liver diseases ; Liver Transplantation ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Medical imaging ; Medical prognosis ; Medical records ; Medical sciences ; Metabolic Syndrome - diagnosis ; Metabolic Syndrome - etiology ; Metabolism ; Mortality ; Obesity - diagnosis ; Obesity - epidemiology ; Other diseases. Semiology ; Oxidative stress ; Phosphatase ; Prognosis ; Studies ; Survival Analysis ; Triglycerides</subject><ispartof>Gut, 2009-11, Vol.58 (11), p.1538-1544</ispartof><rights>BMJ Publishing Group Ltd and British Society of Gastroenterology. All rights reserved.</rights><rights>2009 INIST-CNRS</rights><rights>Copyright: 2009 BMJ Publishing Group Ltd and British Society of Gastroenterology. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b534t-9a61c4cdc17abf32384c8f9e2213a353ae6267f6f7914d5311a53f80c1ff3363</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://gut.bmj.com/content/58/11/1538.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://gut.bmj.com/content/58/11/1538.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,315,781,785,3197,23576,27929,27930,77605,77636</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22023207$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19625277$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Feldstein, A E</creatorcontrib><creatorcontrib>Charatcharoenwitthaya, P</creatorcontrib><creatorcontrib>Treeprasertsuk, S</creatorcontrib><creatorcontrib>Benson, J T</creatorcontrib><creatorcontrib>Enders, F B</creatorcontrib><creatorcontrib>Angulo, P</creatorcontrib><title>The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years</title><title>Gut</title><addtitle>Gut</addtitle><description>Objectives:The long-term prognosis of non-alcoholic fatty liver disease (NAFLD) in children remains uncertain. We aimed at determining the long-term outcomes and survival of children with NAFLD.Design:Retrospective longitudinal hospital-based cohort study.Patients:Sixty-six children with NAFLD (mean age 13.9 (SD 3.9) years) were followed up for up to 20 years with a total of 409.6 person-years of follow-up.Results:The metabolic syndrome was present in 19 (29%) children at the time of NAFLD diagnosis with 55 (83%) presenting with at least one feature of the metabolic syndrome including obesity, hypertension, dyslipidaemia and/or hyperglycaemia. Four children with baseline normal fasting glucose developed type 2 diabetes 4–11 years after NAFLD diagnosis. A total of 13 liver biopsies were obtained from five patients over a mean of 41.4 (SD 28.8) months showing progression of fibrosis stage in four children. During follow-up, two children died and two underwent liver transplantation for decompensated cirrhosis. The observed survival free of liver transplantation was significantly shorter in the NAFLD cohort as compared to the expected survival in the general United States population of the same age and sex (log-rank test, p<0.00001), with a standardised mortality ratio of 13.6 (95% confidence interval, 3.8 to 34.8). NAFLD recurred in the allograft in the two cases transplanted, with one patient progressing to cirrhosis and requiring re-transplantation.Conclusions:Children with NAFLD may develop end-stage liver disease with the consequent need for liver transplantation. NAFLD in children seen in a tertiary care centre may be associated with a significantly shorter survival as compared to the general population.</description><subject>Adolescent</subject><subject>Age</subject><subject>Biological and medical sciences</subject><subject>Biopsy</subject><subject>Body mass index</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cholesterol</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 2 - diagnosis</subject><subject>Diabetes Mellitus, Type 2 - etiology</subject><subject>Early Diagnosis</subject><subject>Epidemiologic Methods</subject><subject>Family medical history</subject><subject>Fasting</subject><subject>Fatty Liver - mortality</subject><subject>Fatty Liver - pathology</subject><subject>Fatty Liver - surgery</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Hepatitis</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infant</subject><subject>Insulin</subject><subject>Insulin resistance</subject><subject>Laboratories</subject><subject>Liver - pathology</subject><subject>Liver cirrhosis</subject><subject>Liver diseases</subject><subject>Liver Transplantation</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical prognosis</subject><subject>Medical records</subject><subject>Medical sciences</subject><subject>Metabolic Syndrome - diagnosis</subject><subject>Metabolic Syndrome - etiology</subject><subject>Metabolism</subject><subject>Mortality</subject><subject>Obesity - diagnosis</subject><subject>Obesity - epidemiology</subject><subject>Other diseases. Semiology</subject><subject>Oxidative stress</subject><subject>Phosphatase</subject><subject>Prognosis</subject><subject>Studies</subject><subject>Survival Analysis</subject><subject>Triglycerides</subject><issn>0017-5749</issn><issn>1468-3288</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqF0cuLFDEQB-Agijuunr1JQEQQejaPzqO9yeALF4VlEG-hJp04PWY6s0m32v-9aXpYwYunoqgvRZEfQk8pWVPK5dX3cVgzQvSaKso0uYdWtJa64kzr-2hFCFWVUHVzgR7lfCAF6oY-RBe0kUwwpVbosN073MMwJgh43-UhpglHj_vYVxBs3MfQWexhGCYcup8u4bbLDrLDXY_tvgttcv1rDNjHEOKvajzhPIztVPqESzNEzAieHKT8GD3wELJ7cq6XaPvu7Xbzobr-8v7j5s11tRO8HqoGJLW1bS1VsPOccV1b7RvHGOXABQcnmVReetXQuhWcUhDca2Kp95xLfoleLmtPKd6OLg_m2GXrQoDexTEbVRCpiZzl83_kIY6pL7cZqlTD65prXdTVomyKOSfnzSl1R0iTocTMIZgSgplDMEsI5cWz895xd3TtX3_-9QJenAFkC8En6G2X7xxjhHFGZlctruTift_NIf0wUnElzOevGyO-SX1zIz6Z2b9a_O54-O-VfwBF8qpy</recordid><startdate>20091101</startdate><enddate>20091101</enddate><creator>Feldstein, A E</creator><creator>Charatcharoenwitthaya, P</creator><creator>Treeprasertsuk, S</creator><creator>Benson, J T</creator><creator>Enders, F B</creator><creator>Angulo, P</creator><general>BMJ Publishing Group Ltd and British Society of Gastroenterology</general><general>BMJ Publishing Group</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20091101</creationdate><title>The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years</title><author>Feldstein, A E ; Charatcharoenwitthaya, P ; Treeprasertsuk, S ; Benson, J T ; Enders, F B ; Angulo, P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b534t-9a61c4cdc17abf32384c8f9e2213a353ae6267f6f7914d5311a53f80c1ff3363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adolescent</topic><topic>Age</topic><topic>Biological and medical sciences</topic><topic>Biopsy</topic><topic>Body mass index</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cholesterol</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 2 - diagnosis</topic><topic>Diabetes Mellitus, Type 2 - etiology</topic><topic>Early Diagnosis</topic><topic>Epidemiologic Methods</topic><topic>Family medical history</topic><topic>Fasting</topic><topic>Fatty Liver - mortality</topic><topic>Fatty Liver - pathology</topic><topic>Fatty Liver - surgery</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Hepatitis</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infant</topic><topic>Insulin</topic><topic>Insulin resistance</topic><topic>Laboratories</topic><topic>Liver - pathology</topic><topic>Liver cirrhosis</topic><topic>Liver diseases</topic><topic>Liver Transplantation</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical prognosis</topic><topic>Medical records</topic><topic>Medical sciences</topic><topic>Metabolic Syndrome - diagnosis</topic><topic>Metabolic Syndrome - etiology</topic><topic>Metabolism</topic><topic>Mortality</topic><topic>Obesity - diagnosis</topic><topic>Obesity - epidemiology</topic><topic>Other diseases. Semiology</topic><topic>Oxidative stress</topic><topic>Phosphatase</topic><topic>Prognosis</topic><topic>Studies</topic><topic>Survival Analysis</topic><topic>Triglycerides</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Feldstein, A E</creatorcontrib><creatorcontrib>Charatcharoenwitthaya, P</creatorcontrib><creatorcontrib>Treeprasertsuk, S</creatorcontrib><creatorcontrib>Benson, J T</creatorcontrib><creatorcontrib>Enders, F B</creatorcontrib><creatorcontrib>Angulo, P</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Gut</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Feldstein, A E</au><au>Charatcharoenwitthaya, P</au><au>Treeprasertsuk, S</au><au>Benson, J T</au><au>Enders, F B</au><au>Angulo, P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years</atitle><jtitle>Gut</jtitle><addtitle>Gut</addtitle><date>2009-11-01</date><risdate>2009</risdate><volume>58</volume><issue>11</issue><spage>1538</spage><epage>1544</epage><pages>1538-1544</pages><issn>0017-5749</issn><eissn>1468-3288</eissn><coden>GUTTAK</coden><abstract>Objectives:The long-term prognosis of non-alcoholic fatty liver disease (NAFLD) in children remains uncertain. We aimed at determining the long-term outcomes and survival of children with NAFLD.Design:Retrospective longitudinal hospital-based cohort study.Patients:Sixty-six children with NAFLD (mean age 13.9 (SD 3.9) years) were followed up for up to 20 years with a total of 409.6 person-years of follow-up.Results:The metabolic syndrome was present in 19 (29%) children at the time of NAFLD diagnosis with 55 (83%) presenting with at least one feature of the metabolic syndrome including obesity, hypertension, dyslipidaemia and/or hyperglycaemia. Four children with baseline normal fasting glucose developed type 2 diabetes 4–11 years after NAFLD diagnosis. A total of 13 liver biopsies were obtained from five patients over a mean of 41.4 (SD 28.8) months showing progression of fibrosis stage in four children. During follow-up, two children died and two underwent liver transplantation for decompensated cirrhosis. The observed survival free of liver transplantation was significantly shorter in the NAFLD cohort as compared to the expected survival in the general United States population of the same age and sex (log-rank test, p<0.00001), with a standardised mortality ratio of 13.6 (95% confidence interval, 3.8 to 34.8). NAFLD recurred in the allograft in the two cases transplanted, with one patient progressing to cirrhosis and requiring re-transplantation.Conclusions:Children with NAFLD may develop end-stage liver disease with the consequent need for liver transplantation. NAFLD in children seen in a tertiary care centre may be associated with a significantly shorter survival as compared to the general population.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Society of Gastroenterology</pub><pmid>19625277</pmid><doi>10.1136/gut.2008.171280</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Age Biological and medical sciences Biopsy Body mass index Child Child, Preschool Cholesterol Diabetes Diabetes Mellitus, Type 2 - diagnosis Diabetes Mellitus, Type 2 - etiology Early Diagnosis Epidemiologic Methods Family medical history Fasting Fatty Liver - mortality Fatty Liver - pathology Fatty Liver - surgery Female Gastroenterology. Liver. Pancreas. Abdomen Hepatitis Hospitals Humans Infant Insulin Insulin resistance Laboratories Liver - pathology Liver cirrhosis Liver diseases Liver Transplantation Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical imaging Medical prognosis Medical records Medical sciences Metabolic Syndrome - diagnosis Metabolic Syndrome - etiology Metabolism Mortality Obesity - diagnosis Obesity - epidemiology Other diseases. Semiology Oxidative stress Phosphatase Prognosis Studies Survival Analysis Triglycerides |
| title | The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years |
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