COLORADO SPRINGS -- Pediatricnon-alcoholic fatty liver disease is strongly associated with multiple cardiovascular risk factors, often in excess of clinical thresholds for considering pharmacotherapy, Dr. Stephen Cook said at a conference of the American Heart Association.

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He added that these new findings from a 300-patient case-control study underscore the importance of routine screening for NAFLD in obese youth as recently recommended by an expert panel comprising representatives of 15 professional organizations (Pediatrics 2007;120:Sl63-288).

NAFLD is "a severe precursor which, if not reversed, is going to be one of the leading causes of liver failure in adult-hood," Dr. Cook said in an interview.

The cardiovascular risk profiles documented in this study raise the prospect that youths with NAFLD may be predisposed to highly premature cardiovascular morbidity and mortality, he noted.

Dr. Cook reported on 150 severely obese children and adolescents with biopsy-proven NAFLD and an equal number of age-, gender-, and obesity-matched controls with normal liver function tests and no hepatomegaly or other signs of NAFLD.

"Across the board, these obese kids with fatty liver had far higher triglycerides, LDL, fasting blood glucose, insulin, blood pressure, and lower HDL than matched controls who were just as obese," he said.

Overall, 80 youths with NAFLD and 35 controls met the three-component definition for metabolic syndrome.

In a logistic regression analysis controlled for age, race, gender, insulin resistance, and body mass index, subjects with NAFLD were two- to sixfold more likely than were controls to exceed treatable thresholds for various cardiovascular risk factors. (See box.)

The recent expert panel recommendations included comprehensive reports on the treatment, prevention, and assessment of pediatric obesity. Panelists recommended that lipid profiles routinely be obtained in youths who are at or above the 85th percentile for BMI, and recommended liver function tests, fasting blood glucose, and lipid profiles in all those at or above the 95th percentile.

Although liver biopsy is required for definitive diagnosis of NAFLD, there is considerable interest in noninvasive screening. Magnetic resonance imaging is probably the best method at present, followed by CT with contrast. Ultrasound is the least informative method, but fatty infiltration does cause the liver to light up on ultrasound, and the attenuation can be compared with the spleen, Dr. Cook said.

NAFLD could 'be one of the leading causes of liver failure in adulthood.'

DR.COOK

Denver Bureau