TAILIEUCHUNG - The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years

The primary objective of the Working Group in developing recommendations for nutrition principles for foods marketed to children has been the promotion of children’s health through better diet, with particular – but not sole – emphasis on reducing the incidence of childhood obesity. The proposed recommendations are therefore designed to encourage children, through advertising and marketing, to choose foods that make a meaningful contribution to a healthful diet (Principle A) and minimize consumption of foods with significant amounts of nutrients that could have a negative impact on health or weight – specifically, sodium, saturated fat, trans fat, and added sugars (Principle B). . | Hepatology tì EDITOR S CHOICE The natural history of non-alcoholic fatty liver disease in children a follow-up study for up to 20 years A E Feldstein 1 P Charatcharoenwitthaya 2 S Treeprasertsuk 2 J T Benson 3 F B Enders 3 P Angulo2 See Commentary p 1442 1 Department of Pediatric and Adolescent Medicine Division of Gastroenterology and Hepatology Mayo Clinic Rochester Minnesota USA 2 Department of Internal Medicine Division of Gastroenterology and Hepatology Mayo Clinic Rochester Minnesota USA 3 Department of Health Sciences Research Division of Biostatistics Mayo Clinic Rochester Minnesota USA Correspondence to Dr P Angulo Division of Digestive Diseases and Nutrition University of Kentucky 800 Rose Street Rm MN469 Lexington KY 40536 USA AF is now at the Cleveland Clinic Foundation Pediatric Gastroenterology and Cell Biology Cleveland Ohio USA. Revised 22 February 2009 Accepted 1 April 2009 Published Online First 21 July 2009 ABSTRACT Objectives The long-term prognosis of non-alcoholic fatty liver disease NAFLD in children remains uncertain. We aimed at determining the long-term outcomes and survival of children with NAFLD. Design Retrospective longitudinal hospital-based cohort study. Patients Sixty-six children with NAFLD mean age SD years were followed up for up to 20 years with a total of person-years of follow-up. Results The metabolic syndrome was present in 19 29 children at the time of NAFLD diagnosis with 55 83 presenting with at least one feature of the metabolic syndrome including obesity hypertension dyslipidaemia and or hyperglycaemia. Four children with baseline normal fasting glucose developed type 2 diabetes 4-11 years after NAFLD diagnosis. A total of 13 liver biopsies were obtained from five patients over a mean of SD months showing progression of fibrosis stage in four children. During follow-up two children died and two underwent liver transplantation for decompensated cirrhosis. The observed survival

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