Nonalcoholic steatohepatitis in children

Background: Nonalcoholic steatohepatitis occurs commonly in adults with obe sity or diabetes mellitus. There are only a few reports of this condition i n children. Methods: prospective consecutive clinical series. Results: Between December 1985 and April 1995, 36 children (21 boys, 15 gir ls) were diagnosed with nonalcoholic steatohepatitis at the Hospital for Si ck Children, Toronto. The median age at diagnosis was 12 years (range, 4-16 years). Most patients were referred because of elevated serum aminotransfe rases or abnormal hepatic sonogram. Thirty patients (83%) were obese. Two p atients had diabetes mellitus at diagnosis, and it developed later in two. Fifteen patients had palpable hepatomegaly, and one of these had splenomega ly. None had physical signs of chronic liver disease. Thirteen of 36 patien ts had acanthosis nigricans. Serum aminotransferases were elevated in all b ur one patient. Tests for Wilson disease and chronic hepatitis B and C were negative. Serum lipid profiles were abnormal in 18 patients: 7 had hyperch olesterolemia, and 11 had hypertriglyceridemia. Twenty-four of 31 examined had abnormal liver sonograms suggestive of fatty infiltration. Twenty-four patients underwent percutaneous liver biopsy: all showed large-droplet fat. Inflammation was present in 88% and fibrosis-cirrhosis in 75%. One 10-year -old patient had established cirrhosis at diagnosis. Conclusions: Nonalcoholic steatohepatitis occurs in children, is clinically diverse, and may not be benign. (C) 2000 Lippincott Williams & Wilkins, In c.