Idiopathic steatohepatitis in childhood: A multicenter retrospective study☆,☆☆,★
Section snippets
Patient selection
We reviewed 650 liver biopsies performed on children (from birth to 18 years of age) between January 1, 1991, and December 31, 1994, at Children's Hospital, Boston, Massachusetts General Hospital, and the University of Massachusetts Medical Center. Eighty-two patients with light microscopic evidence of microvesicular or macrovesicular steatosis were identified. Any patient with evidence of a metabolic, infectious, autoimmune, endocrinologic, toxicologic, or iatrogenic cause of hepatosteatosis
Clinical data
The patients, 10 boys and 4 girls, ranged in age from 10 to 18 years, with an average age of 13.5 years. All were obese, averaging 159% IBW (range, 120% to 222% IBW). The mean height was 106% ± 19% (±1 SD). Biopsies were performed for the evaluation of persistently elevated serum aminotransferase values (>6 months) or as staging procedures in two patients with Hodgkin lymphoma. Of the patients with elevated aminotransferase values, six had abdominal pain associated with acute illness, four had
DISCUSSION
Previous reports have demonstrated steatohepatitis or suspected steatohepatitis in obese children.9, 10, 11, 12 In a recent abstract of a retrospective study of biopsies from patients with idiopathic steatohepatitis at the Hospital for Sick Children, investigators found 26 nondiabetic patients during a 10-year interval, of whom 25 were obese. The average age, male/female ratio, and laboratory values were similar to ours.9 Kinugasa et al.11 demonstrated elevated aminotransferase values in 16.2%
References (15)
- et al.
Alcohollike liver disease in nonalcoholics
Gastroenterology
(1988) - et al.
Fatty liver hepatitis and cirrhosis in obese patients
Am J Med
(1979) NASH: a study of 49 patients
Hum Pathol
(1989)- et al.
Persistent hyperaminotransferasemia resolving after weight reduction in obese children
J PEDIATR
(1994) - et al.
NASH: an expanded clinical entity
Gastroenterology
(1994) - et al.
NASH: Mayo clinic experience with a hitherto unnamed disease
Mayo Clin Proc
(1980) - et al.
The nature of unexplained chronic aminotransferase elevations of a mild to moderate degree in asymptomatic patients
Hepatology
(1989)
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From the Center for Childhood Liver Disease, Combined Program in Pediatric Gastroenterology, the Department of Pathology, Children's Hospital, and the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Reprint requests: Joel E. Lavine, MD, PhD, Joint Program in Pediatric Gastroenterology, University of California San Diego Medical Center, 200 W. Arbor Dr., San Diego, CA 92103-8450.
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