Draijer Laura, Voorhoeve Maaike, Troelstra Marian, Holleboom Adriaan, Beuers Ulrich, Kusters Meeike, Nederveen Aart, Benninga Marc, Koot Bart
Department of Pediatric Gastroenterology and Nutrition, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands.
Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, Amsterdam, the Netherlands.
JHEP Rep. 2023 Jan 25;5(5):100685. doi: 10.1016/j.jhepr.2023.100685. eCollection 2023 May.
BACKGROUND & AIMS: The long-term outcome of paediatric non-alcoholic fatty liver disease (NAFLD) has not been well established. Between 2008 and 2012, an unselected cohort of 133 children with severe obesity was screened for NAFLD. The aim of this study was to determine the 10-year natural history of NAFLD in this cohort.
All 133 participants of the original study were approached. Proton magnetic resonance spectroscopy (H-MRS) and the Enhanced Liver Fibrosis® (ELF) test were used to assess longitudinal changes in steatosis and fibrosis, respectively. Risk factors for disease progression were explored.
Fifty-one of the 133 participants (38%) from the original cohort were included. The mean follow-up time was 10.3 years (range 7-13 years), 65% were female and 92% had persistent obesity. The proportion of participants with steatosis remained unchanged (47%). Nine individuals developed steatosis and in nine individuals steatosis resolved. Predefined relevant individual changes in H-MRS were seen in 38% of the participants. The mean ELF test did not change significantly (8.70 ± 0.58 8.51 ± 0.71, = 0.22). However, 16% had a relevant increase in ELF test and 6% of those with NAFLD developed advanced fibrosis at follow-up. Changes in steatosis correlated with changes in established metabolic risk factors, alanine aminotransferase, and bariatric surgery. A change in the ELF test was associated with a change in triglycerides.
This 10-year follow-up study shows that one-third of the young adults who had childhood obesity develop steatosis and in one-third steatosis resolves. Six percent of those with NAFLD had developed advanced fibrosis at follow-up. These data underscore the importance of screening for NAFLD and monitoring for progression to advanced NAFLD in young people with obesity.
Childhood obesity accompanied by fat accumulation in the liver persists into young adulthood in the vast majority, and 6% develop serious liver injury. Worsening of metabolic disturbances increases the risk of liver injury.
儿童非酒精性脂肪性肝病（NAFLD）的长期预后尚未完全明确。2008年至2012年期间，对133名重度肥胖儿童组成的非特定队列进行了NAFLD筛查。本研究的目的是确定该队列中NAFLD的10年自然病程。
联系了原研究的所有133名参与者。分别使用质子磁共振波谱（H-MRS）和增强肝纤维化（ELF）检测来评估脂肪变性和纤维化的纵向变化。探索了疾病进展的危险因素。
原队列中的133名参与者中有51名（38%）被纳入。平均随访时间为10.3年（范围7 - 13年），65%为女性，92%有持续性肥胖。有脂肪变性的参与者比例保持不变（47%）。9人出现脂肪变性，9人脂肪变性消退。38%的参与者出现了H-MRS中预定义的相关个体变化。平均ELF检测结果无显著变化（8.70±0.58对8.51±0.71，P = 0.22）。然而，16%的参与者ELF检测结果有相关升高，随访时6%的NAFLD患者发展为晚期纤维化。脂肪变性的变化与既定代谢危险因素、丙氨酸氨基转移酶和减肥手术的变化相关。ELF检测的变化与甘油三酯的变化相关。
这项10年随访研究表明，童年肥胖的年轻人中有三分之一发展为脂肪变性，三分之一的脂肪变性消退。随访时6%的NAFLD患者发展为晚期纤维化。这些数据强调了对肥胖青少年进行NAFLD筛查和监测其进展为晚期NAFLD的重要性。
童年肥胖伴肝脏脂肪堆积在绝大多数情况下会持续到青年期，6%的人会发展为严重肝损伤。代谢紊乱的恶化会增加肝损伤风险。
