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. 2018 Mar;16(3):438-446.e1.
doi: 10.1016/j.cgh.2017.02.030. Epub 2017 Mar 7.

In Children With Nonalcoholic Fatty Liver Disease, Zone 1 Steatosis Is Associated With Advanced Fibrosis

Jonathan A Africa  1 , Cynthia A Behling  2 , Elizabeth M Brunt  3 , Nan Zhang  4 , Yunjun Luo  4 , Alan Wells  5 , Jiayi Hou  5 , Patricia H Belt  6 , Rohit Kohil  7 , Joel E Lavine  8 , Jean P Molleston  9 , Kimberly P Newton  1 , Peter F Whitington  10 , Jeffrey B Schwimmer  11 ; Nonalcoholic Steatohepatitis Clinical Research Network
Collaborators, Affiliations

In Children With Nonalcoholic Fatty Liver Disease, Zone 1 Steatosis Is Associated With Advanced Fibrosis

Jonathan A Africa et al. Clin Gastroenterol Hepatol. 2018 Mar.

Abstract

Background & aims: Focal zone 1 steatosis, although rare in adults with nonalcoholic fatty liver disease (NAFLD), does occur in children with NAFLD. We investigated whether focal zone 1 steatosis and focal zone 3 steatosis are distinct subphenotypes of pediatric NAFLD. We aimed to determine associations between the zonality of steatosis and demographic, clinical, and histologic features in children with NAFLD.

Methods: We performed a cross-sectional study of baseline data from 813 children (age <18 years; mean age, 12.8 ± 2.7 years). The subjects had biopsy-proven NAFLD and were enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network. Liver histology was reviewed using the Nonalcoholic Steatohepatitis Clinical Research Network scoring system.

Results: Zone 1 steatosis was present in 18% of children with NAFLD (n = 146) and zone 3 steatosis was present in 32% (n = 244). Children with zone 1 steatosis were significantly younger (10 vs 14 years; P < .001) and a significantly higher proportion had any fibrosis (81% vs 51%; P < .001) or advanced fibrosis (13% vs 5%; P < .001) compared with children with zone 3 steatosis. In contrast, children with zone 3 steatosis were significantly more likely to have steatohepatitis (30% vs 6% in children with zone 1 steatosis; P < .001).

Conclusions: Children with zone 1 or zone 3 distribution of steatosis have an important subphenotype of pediatric NAFLD. Children with zone 1 steatosis are more likely to have advanced fibrosis and children with zone 3 steatosis are more likely to have steatohepatitis. To achieve a comprehensive understanding of pediatric NAFLD, studies of pathophysiology, natural history, and response to treatment should account for the zonality of steatosis.

Keywords: Disease Progression; NASH; Obesity; Pediatric.

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