Histologic spectrum of nonalcoholic fatty liver disease in morbidly obese adolescents
ABSTRACT To characterize the spectrum of nonalcoholic fatty liver disease (NAFLD) in morbidly obese adolescents, we correlated liver histology with clinical features and compared findings with reported adult data. We hypothesized that NAFLD would be less severe as a result of younger age and shorter duration of obesity, but portal inflammation and fibrosis would be more prevalent.
Cross-sectional study was made of 41 adolescent subjects, 13-19 years old (mean, 16 years), 61% female, 83% non-Hispanic white, mean body mass index 59 kg/m(2), undergoing gastric bypass with liver biopsy. Liver biopsies were graded and staged as proposed by the NASH Clinical Research Network. Data were analyzed by using descriptive statistics, analysis of variance, and Fisher exact tests.
Eighty-three percent had NAFLD: 24% steatosis alone, 7% isolated fibrosis with steatosis, 32% nonspecific inflammation and steatosis, and 20% nonalcoholic steatohepatitis (NASH). Twenty-nine percent had fibrosis; none had cirrhosis. Abnormal ALT (P = .05) and AST (P = .01) were more prevalent in NASH. Mean fasting glucose was significantly higher in NASH (P = .05), but prevalence of the metabolic syndrome was not significantly different.
NAFLD was very prevalent in morbidly obese adolescents, but severe NASH was uncommon. In contrast to morbidly obese adults, lobular inflammation, significant ballooning, and perisinusoidal fibrosis were rare, whereas portal inflammation and portal fibrosis were more prevalent, even in those who did not meet criteria for NASH. These findings might support use of a modified scoring system for pediatric NASH. Presence of the metabolic syndrome in morbidly obese adolescents did not distinguish NASH from steatosis alone.
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ABSTRACT: Examines the effects of bariatric surgery on adolescent obesity. The risks and outcomes of bariatric surgery in adolescence are presently being defined and may be somewhat different from those in adults. Adolescents may have a greater risk of weight regain, and greater risk of noncompliance to treatment after surgery. However, long-term outcomes are not yet available, and the underlying metabolic benefits appear to be substantial and similar to those of adults. Morbid obesity in adolescents has severe acute and chronic complications. Bariatric surgery in adolescents seems as well tolerated as in adults when performed in centers with appropriate experience and adequate surgical volume. The pathophysiologic implications of bariatric surgery are profound. A better understanding of the mechanisms leading to postsurgical improvement in insulin resistance and weight loss could lead to the development of other therapies to achieve the same effects with lesser morbidities.Current opinion in endocrinology, diabetes, and obesity 03/2009; 16(1):37-44. DOI:10.1097/MED.0b013e32832101ff · 3.77 Impact Factor
- Surgical Clinics of North America 05/2006; 86(2):441-54, x. DOI:10.1016/j.suc.2005.12.015 · 1.93 Impact Factor
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ABSTRACT: L'hépatopathie non alcoolique est une entité reconnue récemment qui est liée à notre mode de vie moderne et qui a une importance clinique croissante parallèle à l'augmentation de la fréquence de l'obésité et du diabète de type II. Elle est considérée comme la complication hépatique du syndrome métabolique car elle est associée à une résistance à l'insuline. Elle se présente comme un spectre de lésions hépatiques allant de la stéatose isolée à la cirrhose constituée. Jusqu'à présent, seule la réalisation d'une biopsie hépatique permet d'établir l'existence d'une stéatohépatite qui est la forme progressive de la maladie. La pathogénie de l'hépatopathie non alcoolique implique plusieurs mécanismes potentiels dans un processus probablement séquentiel. Aucun traitement n'est réellement reconnu ou validé à l'heure actuelle.Acta Endoscopica 06/2006; DOI:10.1007/BF03006037 · 0.16 Impact Factor