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Abstract
Background Obesity has become a major public health issue for developed countries with a third of 9-year olds in the UK now overweight or obese. This has meant a rise in paediatric non-alcoholic fatty liver disease (NAFLD), a term that includes a spectrum of disease from simple steatosis to non-alcoholic steatohepatitis (NASH), to fibrosis and cirrhosis. Sarcopenia is characterized by loss of skeletal muscle mass and is associated with metabolic syndrome, diabetes mellitus, and cardiovascular diseases. Adult studies suggest that sarcopenia is associated with more advanced NASH and/or liver fibrosis in the context of NAFLD.
Aim The aim of this study is to assess body composition of children with NAFLD and to evaluate associations with histological features, inflammatory profiles, insulin resistance and activity scores. Here we present the interim results from 7 patients.
Methods Children with a histological diagnosis of NAFLD would have a whole body DXA scan, basic anthropometry, bioelectrical impedance, acoustic radiation force impulse (ARFI) with their ultrasound, enhanced liver fibrosis (ELF) score and routine bloods. They would also answer a physical activity questionnaire (PAQ). Non-parametric tests were used to assess for correlations and differences between groups.
Results Seven children have completed their assessment (6M:1F). Median for age was 14 years (SD 2.1), weight z-score 2.46 (SD 0.73), height z-score 0.45 (SD 0.82), BMI z-score 2.24 (SD 0.52), waist circumference (WC) z-score 1.87 (0.62), waist to height (Wt/Ht) z-score median 1.8 (SD 0.68).
From the DXA scan: median total fat mass index (FMI) z-score 1.69 (range 0.74 to 2.26), fat-free mass index (FFMI) z-score 0.93 (-0.72 to 1.08).% fat mass median 38.7, (range 25.4% to 46.5%). FMI z-score had a significant negative correlation with cholesterol levels (-0.85)* and positive with WC z-score (0.79)* and Wt/Ht z-score (0.79)*.
The histological fibrosis score had a significant positive correlation with age (-0.82)* and ELF score (0.79)* and significant negative correlation with total body water (-0.9)**, extra-cellular water (-0.85)*, intra-cellular water (-0.89)**, body cell mass (-0.83)*. The NAS score correlated significantly with WC z-score (0.81)*, Wt/Ht z-score (0.81)* and PLTs (0.88)** and negative correlation with ARFI (-0.85)*.
Only 2/7 children had a Wt/Ht ratio below the 80th percentile (the figure 1 shows only the boys) and these 2 children had a low NAS score (of 1) and fibrosis of 0 and 1. They had the lowest platelets (below 250).
Summary/Conclusion Due to the pandemic there have been delays in this study and these are interim results. The aim is for 20 patients to be measured and a cytokine panel will be included in their assessment when all samples have been collected.
Within this data, the degree of fibrosis correlates with BCM, which is a measure of lean mass, but not with total FFMI as per DXA scan. As expected it correlated with ELF score. Whereas the NAS score, which reflects more the degree of steatohepatitis/inflammation correlated with platelets, waist circumference and waist circumference to height ratio.
This study is being funded by the Children’s Liver Disease Foundation.
Waist to height ratio percentiles for the boys. P<0.05*, p<0.01**