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The natural history of nonalcoholic fatty liver disease in children: A follow-up study for up to 20-years
  1. Ariel E Feldstein (feldsta{at}
  1. Cleveland Clinic, United States
    1. Phunchai Charatcharoenwitthaya
    1. Mayo Clinic, United States
      1. Sombat Treeprasertsuk
      1. Mayo Clinic, United States
        1. Joanne T Benson
        1. Mayo Clinic, United States
          1. Felicity B Enders
          1. Mayo Clinic, United States
            1. Paul Angulo (angulo.paul{at}
            1. Mayo Clinic, United States


              Objectives: The long-term prognosis of nonalcoholic 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 13.9±3.9 years) were followed-up for up to 20 years with a total of 409.6 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, dyslipidemia and/or hyperglycemia. Four children with baseline normal fasting glucose developed type II diabetes 4-11 years after NAFLD diagnosis. A total of 13 liver biopsies were obtained from five patients over a mean of 41.4±28.8 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 free of liver transplantation was significantly shorter in the NAFLD cohort as compared to the expected survival in the general United States population of the same age and sex (log-rank test, p<0.00001), with a standarized mortality ratio of 13.6 (95% CI 3.8, 34.8). NAFLD recurred in the allograft in the two cases transplanted, with one case progressing to cirrhosis and requiring re-transplantation.

              Conclusions: Children with NAFLD may develop end-stage liver disease with the consequent need for liver transplantation. NAFLD in children seen in a tertiary care center may be associated with a significantly shorter survival as compared to the general population.

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