Increased atherogenic lipoprotein profile in children with non-alcoholic steatohepatitis
Summary
Background
Non-alcoholic fatty liver disease (NAFLD) has been shown to be an independent risk factor for cardiovascular disease. In adults, histologic severity of non-alcoholic steatohepatitis (NASH) is associated with a more atherogenic profile.
Objective
To assess cardiovascular disease risk by lipoprotein profile in children with NAFLD and compare to histologic assessment of severity.
Methods
Nuclear magnetic resonance lipoprotein profile including lipoprotein particle sizes, apolipoproteins and the lipoprotein insulin resistance (LP-IR) index was measured in serum samples collected from 76 children at the time of a clinically indicated liver biopsy for NAFLD. Liver histology was scored using the NASH Clinical Research Network criteria and grouped into NASH or non-NASH.
Results
Children with NASH had higher apolipoprotein B to apolipoprotein AI, ApoB/ApoAI (0.56 [IQR, 0.45-0.70] vs 0.66 [IQR, 0.56-0.79], P = .02) and higher LP-IR index (61 ± 21.9 vs 68 ± 17.3, P = .05) compared to children with non-NASH. Severity of hepatocyte ballooning was associated with higher ApoB/ApoAI ratios (P = .01), while high-density lipoprotein size was inversely associated with hepatic fat accumulation (P = .04).
Conclusion
While dyslipidaemia is common among children with NAFLD, this data suggests severity of the histologic features is closely associated with severity of cardiometabolic risk. Further studies are needed to understand the role of treatment of NASH in children to prevent future cardiometabolic disease.
CONFLICT OF INTEREST
M. B. V. reports non-financial support from LabCorp during the conduct of the study. M. B. V. receives personal fees from AMRA, Boehringer Ingelheim, Bristol Myers Squibb, Intercept, Novo Nordisk, Mallinckrodt Pharmaceuticals, grants and personal fees from Target Pharmasolutions, grants from Immuron, grants and personal fees from Target Pharmasolutions, personal fees from Novo Nordisk, outside the submitted work. M. A. C. is an employee of LabCorp, a company that is marketing the LP-IR test for clinical diagnostic use. However, M. A. C. had no role in the design of the study or in the decision to publish the results. All other authors declare that they have no conflicts of interest.
