Metabolic syndrome and liver histology in paediatric non-alcoholic steatohepatitis

Objective: Our aim was to estimate prevalence of metabolic syndrome (MS), obesity and comorbidities in a cohort of 120 children (3-18 years) with biopsy-proven non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) and to evaluate correlations between clinical or biochemical variables and liver histology. Research methods and procedures: MS was diagnosed according to the adapted National Cholesterol Education Program criteria. Homeostatic model assessment of insulin resistance (HOMA-IR), quantitative insulin-sensitivity check index (QUICKI); and ISI composite, insulin secretion (insulin response at 30 min after a glucose load; HOMA-beta cell; insulinogenic index) were all estimated. BMI z-score and total body fat (dual-energy X-ray absorptiometry) were evaluated as indexes of obesity. Results: MS was diagnosed in 66% of children. About 92% had weight above the 85th percentile, of which 42% were obese with weight above 97th percentile. Prevalence of hypertriglyceridaemia was 63%, low HDL cholesterol 45%, hypertension 40% and impaired glucose tolerance 10%. Levels of aminotransferases were higher as the number of comorbidities increased, the highest values being found in subjects with MS (P <= 0.05). Prevalence of a grade of steatosis >= 2 (P = 0.05) and fibrosis (P <= 0.01) was higher in subjects with MS. Histology was associated significantly with higher values of a number of clinical and biochemical parameters (steatosis >= 2 with BMI z-score (P = 0.04), fasting insulin (P = 0.02), HOMA-IR (P = 0.03), beta-cell secretion (P = 0.04); necroinflammation with BMI z-score (P = 0.007), glucose (P <= 0.0001), cholesterol (P <= 0.04) and white blood cells (P = 0.025); fibrosis with body weight (P = 0.05), BMI z- score (P = 0.03), cholesterol (P = 0.05), triglycerides (P = 0.05), fasting insulin (P <= 0.0001) and mean values of the hormone at the OGTT (P = 0.03), HOMA-IR (P <= 0.0001)). Conclusion: Presence of MS or clinical and biochemical variables associated with the syndrome seems to be strictly related to histological features of NASH in paediatric fatty liver disease. Thus, routinely liver biopsy should be encouraged in these children.