A natural history study of paediatric non-alcoholic fatty liver disease over 10 years

Background & Aims The long-term outcome of pediatric 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. Methods All 133 participants of the original study were approached. Proton Magnetic Resonance Spectroscopy ( 1 H-MRS) and Enhanced Liver Fibrosis (ELF) test were used to assess longitudinal changes in steatosis and fibrosis, respectively. Risk factors for disease progression were explored. Results Fifty-one of the 133 subjects (38%) from the original cohort were included. The mean follow-up time was 10.3 years (range 7-13 years), 65% was female and 92% had persistent obesity. The proportion of subjects with steatosis remained unchanged (47%). Nine subjects developed steatosis and in 9 subjects steatosis resolved. Predefined relevant individual changes in 1 H-MRS were seen in 38% of the subjects. The mean ELF test did not change significantly (8.70 ± 0.58 versus 8.51 ± 0.71, p=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, ALT and bariatric surgery. Change in ELF test was associated with change in triglycerides. Conclusions 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 to screen for NAFLD and monitor for progression to advanced NAFLD in the young with obesity. Lay Summary Childhood obesity accompanied by fat accumulation in the liver persists into young adulthood in the vast majority, and 6% develops serious liver injury. Worsening of metabolic disturbances increases the risk of liver injury.