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Children and young adults with non-alcoholic fatty liver disease (NALFD) have significantly higher mortality than the general population. According to the study published in Journal of hepatology, the excess mortality was mainly due to cancer, cardiometabolic disease and liver disease.
Researchers evaluated a national cohort of pediatric and young adult patients in Sweden with biopsy-confirmed NAFLD and compared them to matched controls from the general population to analyze overall and cause-specific mortality based on presence and the severity of NAFLD.
Although there have been studies of NAFLD in adults, little is known “about the long-term prognosis and histologic correlates of survival” in children and young adults with NAFLD, explained the researchers. authors. They noted that 7.6% of the general pediatric population worldwide and over 30% of obese children suffer from NAFLD.
Children who are diagnosed with NAFLD may already have fibrosis and rapid progression to non-alcoholic steatohepatitis (NASH), a severe form of NAFLD.
The study included 718 children and young adults with NAFLD. Of these individuals, 446 (62.1%) had simple steatosis and 272 (37.9%) had NASH. Less than half (44%) were diagnosed before the age of 18. Compared to the control population (n = 3457), patients with NAFLD were more likely to have cardiovascular disease (1.4% vs. 6.8%), diabetes (0.3% vs. 5.6% ), and other metabolic comorbidities (0.5% vs 13.6%).
During the follow-up period (median 15.8 years for NAFLD patients and 16.9 years for controls), 59 patients with NAFLD died for a mortality rate of 5.5 / 1000 person-years compared to 36 death among controls for a mortality rate of 0.65 / 1000 person-years. The absolute risk of overall mortality over 20 years was 7.7% for the NAFLD cohort and 1.1% for the controls, “which translated into 1 additional death for every 15 patients with NAFLD, followed for 20 years. years, ”wrote the authors.
As the severity of NAFLD increased, the risk of overall mortality also increased. Patients with simple steatosis had an absolute risk of death at 20 years which was 5.7% higher than controls and patients with NASH had an absolute risk of mortality at 20 years which was 8.4% higher.
Patients with NAFLD, compared to controls, had increased mortality due to:
- Cancer (1.67 vs 0.07 / 1000 person-years)
- Cardiometabolic disease (1.12 vs 0.14 / 1000 person-years)
- Liver disease (0.93 vs. 0.04 / 1000 person-years)
- Other / exogenous causes (1.8 vs 0.4 / 1000 person-years)
Among the limitations of the study, the authors noted that because it was a retrospective study of children and young adults who had a biopsy, there could be selection bias. Additionally, since the Swedish population is predominantly white and has a low prevalence of pediatric obesity, further studies with larger and diverse populations are needed.
“… Our results underscore the need to improve prevention, risk stratification and surveillance strategies in order to improve long-term outcomes for this growing patient population,” the authors concluded.
Reference
Simon TG, Roelstraete B, Hartjes K, et al. Non-alcoholic fatty liver disease in children and young adults is associated with increased long-term mortality. J Hepatol. Published online July 2, 2021. doi: 10.1016 / j.jhep.2021.06.034
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