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P0225 10-CENTRE-REVIEW OF NON-ALCOHOLIC FATTY LIVER DISEASE IN CHILDREN

Baumann, U.1; Ballauff, A.2; Enninger, A.3; Gerner, P.4; Kaeding, M.5; Koletzko, S.6; Lang, T.7; Muller, H.8; Pittschieler, K.9; Schulz, A.10; Engelmann, G.11

Journal of Pediatric Gastroenterology and Nutrition: June 2004 - Volume 39 - Issue - p S143-S144
ABSTRACTS: Poster Session Abstracts
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1The Liver Unit, Birmingham Children’s Hospital, Birmingham, United Kingdom,2Abt. fur allg. Kinderheilkunde, Universitatskinderklink, Essen,3Abt. fur allg. Kinderheilkunde I, Olgahospital, Stuttgart,4Abt. fur allg. Kinderheilkunde, Helios Klinikum Wuppertal GmbH, Wuppertal,5Kinderklinik, Klinikum Chemnitz GmbH, Chemnitz,6Kinderklinik, Ludwig-Maximilians-Universitat, Munchen,7Kinderklinik, Klinik St. Hedwig, Regensburg,8Kinderklinik, Klinikum Kempten, Kempten, Germany,9Kinderklinik, Zentralkrankenhaus, Bozen, Italy,10Kinderklinik, Universitatskliniken Hamburg Eppendorf, Hamburg,11Abteilung fur allgemeine Kinderheilkunde, Universitatskinderklink, Heidelberg, Germany

Submitted by: Ulrich.baumann@bch.nhs.uk

Introduction: Non alcoholic fatty liver disease (NAFLD) is a new and often undiagnosed entity of chronic liver disease with an uncertain prognosis. The term NAFLD covers a spectrum from static disease to more aggressive forms that can progress to cirrhosis within childhood. Adult data suggests that this subgroup displays histological features of non-alcoholic steatohepatitis (NASH). The aim of this survey was to pool the data of patients from 10 centres and compare the different approach to affected children.

Methods: Ten centres in Germany and Italy contributed data on 44 children aged from 5 years 11 months up to 16 years 6 month. All patients were obese with body mass indices ranging from 19.5 kg/m2 (94.2 Pc, SDS LMS 1.57) to 42.72 (99.94 Pc, 3.24 SDS LMS). The diagnosis of NAFLD was based on liver biopsy result or on the trias abnormal liver function test, obesity and ultrasound report suggestive of steatosis.

Results: Six patients were excluded from further analysis because they did not fullfill all criteria. 18 of the remaining children had a liver biopsy, of whom 12 had features of (NASH) according to AASLD consensus the remaining 6 fell into the group of presumed static steatosis of the liver, usually also called NAFLD. BMIs, age of patient or serum transaminases were not significantly different in both groups, whereas in the group with NASH a significantly higher platelet count was observed (Mann-Whitney, p= .031). Statistical analysis suggested a platelet count of > 296000/μl to have a sensitivity of 83 % and a specificity of 66% to detect NASH. According to this criteria amongst the non-biopsied patients 13 out of 20 had a high platelet count that is suggestive of NASH.

Conclusion: We conclude that a more standardized approach to non-alcoholic fatty liver disease would be useful. Further studies are necessary to define the prognosis of NAFLD and its subgroup NASH and to investigate treatment options for the affected patients. Only then medical management of children with fatty liver disease can become uniform and late complications can hopefully be minimized.

© 2004 Lippincott Williams & Wilkins, Inc.