Obesity, insulin resistance, and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease

Objective To describe the clinical characteristics of nonalcoholic fatty liver disease (NAFLD) in children, including insulin resistance, and to test for correlation with liver pathology. Study design A retrospective review of children with biopsy-proven NAFLD at Children's Hospital San Diego from 1999 to 2002. Liver biopsy specimens were independently reviewed by two pathologists. Results Children with NAFLD (n = 43) were mostly male (70%), Hispanic American (53%) and obese (88%). The criteria for insulin resistance were met by 95% of subjects. Steatosis was predicted by the combination of quantitative insulin sensitivity check index, age, and ethnicity (P < .0001). Portal inflammation was predicted by the combination of ALT and fasting insulin (P = .0009). Perisinusoidal fibrosis was predicted by the combination of AST, fasting insulin, and BMI Z score (P < .0001). Portal fibrosis was predicted by the combination of right upper quadrant pain and homeostasis model assessment of insulin resistance (P = .0028). Conclusions We identified significant predictors of liver pathology in children with NAFLD. Children being evaluated for NAFLD should be screened for insulin resistance, which is nearly universal and correlates with liver histology.