Portal inflammation is independelty associated with fibrosis and metabolic syndrome in paediatric nonalcoholic fatty liver disease

Paediatric non-alcoholic fatty liver disease (NAFLD) histology demonstrates variable amounts of portal inflammation, which may be associated with more severe liver disease and fibrosis. We aimed to assess the relationship between portal inflammation, hepatic fibrosis, and the metabolic syndrome in paediatric NAFLD. Children with biopsy-proven NAFLD were eligible for inclusion. Histology was assessed using Kleiner fibrosis stage and the NASH CRN system for portal inflammation. Patients were divided by histology into: type 1, type 2, and overlap NAFLD. Multivariable ordinal logistic regression was used to determine factors associated with fibrosis and portal inflammation. 430 Caucasian children were divided into 52 with type 1 NAFLD, 95 with type 2, and 283 with overlap NAFLD. Type 2 had a more severe metabolic phenotype, with higher body mass index z-score (2.0 vs. 1.6, p<0.0001), waist circumference centile (96(th) vs. 90(th) , p<0.0001), higher triglycerides (84 vs. 77 mg/dL, p=0.01), and lower HDL (46 vs. 60 mg/dl, p=0.004) than those with type 1. Similarly, overlap NAFLD had a more severe phenotype. Stage 2-3 fibrosis was present in 69/283 (24%) overlap NAFLD. Portal inflammation was associated with stage 2-3 fibrosis on multivariable analysis (95% CI 1.4-5.2, odds ratio 3.7). Waist circumference centile was associated with portal inflammation (95% CI 1.2-3.4, odds ratio 2.0).

CONCLUSION: Portal inflammation is associated with more advanced paediatric NAFLD and features of the metabolic syndrome. This article is protected by copyright. All rights reserved.