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Psychotropic Medications are Associated with Increased Liver Disease Severity in Pediatric NAFLD

Mouzaki, Marialena*; Yodoshi, Toshifumi*; Arce-Clachar, Ana Catalina*; Bramlage, Kristin*; Fei, Lin; Hunsaker, Sanita L.; Xanthakos, Stavra A.*

Journal of Pediatric Gastroenterology and Nutrition: May 18, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002401
Original Article: Hepatology: PDF Only
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Objectives: To determine whether pediatric patients with non-alcoholic fatty liver disease (NAFLD) exposed to psychotropic medications have more severe liver disease compared to their counterparts who are not on these medications. We hypothesize that use of psychotropic agents is associated with liver disease severity.

Methods: Children and adolescents with biopsy confirmed NAFLD were included in this study. Histology data, detailed clinical information and results of serum biochemistries performed within three months of the liver biopsy were collected retrospectively. Univariate and multivariate modeling was used to determine differences between the groups and to control for confounders.

Results: 228 patients were included, 17 (8%) of whom where on psychotropic medications at the time of the liver biopsy. Patients on psychotropic medications were more likely to also be on metformin (53% vs. 18%, p < 0.01) and anti-hypertensive medications (29% vs. 8%, p < 0.01) compared to children with NAFLD who were not on psychotropic agents. There were no differences in regards to biochemical evidence of liver injury, insulin resistance and dyslipidemia between the groups. On histology however, the use of psychotropic medications was associated with increased steatosis severity (score 2.4 vs. 1.9, p = 0.04) and increased likelihood of having a NAFLD Activity Score ≥5 (seen in 59% vs. 35% or patients; p = 0.05, respectively).

Conclusions: In this large cohort of children with biopsy confirmed NAFLD, the use of psychotropic medications was associated with increased liver disease severity. Exposure to psychotropic agents should be considered when risk stratifying children with NAFLD.

*Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center; University of Cincinnati School of Medicine, Cincinnati, Ohio

Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center; University of Cincinnati School of Medicine, Cincinnati, Ohio

Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center; University of Cincinnati School of Medicine, Cincinnati, Ohio.

Address correspondence and reprint requests to Marialena Mouzaki, MD MSc, Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 (Marialena.mouzaki@cchmc.org).

Received 30 January, 2019

Accepted 10 April, 2019

Contributors’ Statement Page:

Dr. Mouzaki conceptualized and designed the study, coordinated and supervised data collection, carried out the initial analyses, drafted the initial manuscript, and reviewed and revised the manuscript.

Dr. Xanthakos conceptualized and designed the study, assisted with interpretation of the data and critically reviewed the manuscript for important intellectual content.

Dr. Yodoshi assisted with data collection and analyses, and critically reviewed and revised the manuscript for important intellectual content.

Dr. Fei assisted with the analyses, and critically reviewed the manuscript for important intellectual content.

Drs. Arce-Clachar, Bramlage, and Hunsaker participated in the interpretation of the data, critically reviewed and revised the manuscript for important intellectual content.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Funding Source: No external funding for this manuscript.

Financial Disclosure: The authors have no relevant financial disclosures.

Conflict of Interest: None of the authors have any potential competing interest to be declared.

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© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,