Low, high birth weights increase risk for fatty liver, fibrosis in children
Low birth weight and high birth weight were associated with the development of non-alcoholic fatty liver disease in children and both appear to increase the risk for more severe diseases such as non-alcoholic steatohepatitis or advanced fibrosis, according to a recently published study.
“What our research found is that low birth weight and high birth weight were both associated with the severity of liver disease, but in different ways,” Jeffrey B. Schwimmer, MD, professor of pediatrics at University of California San Diego School of Medicine and director of the Fatty Liver Clinic at Rady Children’s Hospital-San Diego, said in a press release. “Children with low birth weight were more likely to develop severe scarring of the liver. However, children with high birth weight were more likely to develop the hepatitis form of fatty liver disease.”
The multicenter, cross-sectional study comprised 538 children with NAFLD. Mean patient age was 13 years, median BMI was 32 kg/m2 and 71% were boys. The children were categorized as having had low birth weight (1,500-2,499 g), normal birth weight (2,500-3,999 g) or high birth weight (4,000 g). Fifty children had low birth weight, 408 had normal birth weight and 80 had high birth weight. NASH was present in 26.6% of the children.
There were no significant differences in age, sex or ethnicity among the children. At the time of NAFLD diagnosis, however, there was a significant difference between height and weight by birth weight category (P < .001). The distribution of low and high birth weight categories was significantly higher in the study group compared with general U.S. population of children (P < .0001).
Forty-one of the children in the high birth weight category had severe steatosis, representing 1.82-fold greater odds of having more severe steatosis compared with children in the normal birth weight category (OR = 1.82; 95% CI, 1.15-2.88).
“Although obtaining maternal health information was beyond the scope of this investigation, previous studies have shown that mothers with elevated BMI and diabetes are prone to have children born large for gestational age, and that hepatic steatosis is more likely to be present at birth in these infants,” the researchers wrote. “Importantly, in our study, the children with [high birth weight] not only had more severe steatosis, but also had greater odds of having NASH. Thus, [high birth weight] may be an early marker for imprinting that predisposes a child to NAFLD itself as well as for more severe disease in the form of steatohepatitis.” NASH was present in 15 children with low birth weight, 96 with normal birth weight and 32 with high birth weight (P < .01). The odds of children with high birth weight having NASH were 2.03-fold greater compared with children with normal birth weight (OR = 2.03; 95% CI, 1.21-3.4).
Advanced fibrosis was present in 12 children with low birth weight, 52 with normal birth weight and 13 with high birth weight (P = .09). The odds of children with low birth weight having advanced fibrosis were 2.23-fold greater compared with children with normal birth weight (OR = 2.23; 95% CI, 1.08-4.62).
“This is the first study to show that extremes of weights on either side of the normal spectrum are connected to an increased risk for NAFLD,” Schwimmer said. “Children who are born with low birth weight or high birth weight may merit closer attention to their metabolic health to help prevent obesity, liver disease and diabetes.”– by Talitha Bennett
Disclosure: The researchers report no relevant financial disclosures.