Original articleLiver, pancreas, and biliary tractAssociation Between Puberty and Features of Nonalcoholic Fatty Liver Disease
Section snippets
Study Design and Population
We performed a cross-sectional analysis by using data from the NASH CRN Database study and the Treatment of NAFLD in Children (TONIC) clinical trial. The study design and data collected from the NAFLD Database study and TONIC trial have been reported recently.15, 16 Our study population required the following criteria: (1) age at enrollment was <18 years, (2) the presence of liver histologic data, (3) no chronic liver diseases other than NAFLD as assessed by serologies and/or histology, and (4)
Clinical Characteristics
A total of 186 children (age <18 years) with NAFLD were analyzed. Median and interquartile range (in months) of difference between the time of liver biopsy and the time of the clinical data collection were 2 (1, 2). Clinical characteristics of the patients were significantly different among the 3 pubertal stages (Table 2). As anticipated, pubertal development increased along with growth, age, and all the anthropometric measures; the associations were statistically significant, except for
Discussion
We conducted a cross-sectional analysis by using the largest prospective pediatric NAFLD database and found that pubertal stages were associated with regional anthropometric measures, clinical features of insulin resistance, and the severity of several histologic features of NAFLD. Pubertal stages were univariately associated with the severity of steatosis, portal inflammation (borderline), Mallory–Denk bodies, and the diagnostic categories of steatohepatitis in the overall population. Children
Acknowledgments
Members of the Nonalcoholic Steatohepatitis Clinical Research Network, Pediatric Clinical Centers, are listed in the Appendix.
The authors thank Dr Yuliya Lokhnygina, Department of Biostatistics, Duke University, Durham, NC, for her critical consideration and insight regarding statistical approach used in this analysis and her assistance in statistical analysis.
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2021, ToxicologyCitation Excerpt :Thus, we cannot exclude the possibility that in puberty these residual levels result in changes to the cholesterol metabolism (increase in HDL), an increase in estrogen synthesis in puberty, changes to the iron metabolism in the liver (Kolatorova et al., 2018) and induction of oxidative stress (Hanada et al., 2010) leading to liver damage. There is also puberty-induced insulin resistance that further exhibits adverse effects on liver cells (Suzuki et al., 2012). As concluded by Maradonna and Carnevali (2018), an increase in estrogen levels in puberty affects the liver lipid metabolism which in association with exogenous toxicants may deteriorate the liver.
Conflicts of Interest The authors disclose no conflicts.
Funding This publication was made possible by grant number UL1RR024128 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.
The Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (grants U01DK061718, U01DK061728, U01DK061731, U01DK061732, U01DK061734, U01DK061737, U01DK061738, U01DK061730, U01DK061713) and the National Institute of Child Health and Human Development (NICHD). Several clinical centers use support from General Clinical Research Centers or Clinical and Translational Science Awards in conduct of NASH CRN Studies (grants UL1RR024989, M01RR000750, M01RR00188, UL1RR02413101, M01RR000827, UL1RR02501401, M01RR000065, M01RR020359). Dr Manal Abdelmalek is supported by an NIH/NIDDK K23 Career Development award (K23-DK062116).