COLORADO SPRINGS — Pediatric nonalcoholic 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.

Moreover, the prevalence of metabolic syndrome in children and
adolescents with nonalcoholic fatty liver disease (NAFLD) is twice
that seen in equally obese youths without the hepatic disease,
according to Dr. Cook, of the University of Rochester (N.Y.) Medical
Center.

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:S163–288).

NAFLD is “a severe precursor which, if not reversed, is going to be
one of the leading causes of liver failure in adulthood,” 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.

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A simple parable given in hopes of promoting much greater
understanding:

http://HeartMDPhD.com/Parable

Life in industrialized nations is life in feed lots.  It is up to
parents to figure out what is the right amount of food for their
children.  Because the right amount for the parents is 32 ounces, the
right amount for their children will be varying degrees less.

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http://HeartMDPhD.com/HolySpirit/Counsels