High and low birth weights linked to non-alcoholic fatty liver disease, more severe disease in children

Both high birth weight (HBW) and low birth weight (LBW) affect the development of non-alcoholic fatty liver disease (NAFLD) in children, and lead to not only an increased risk for disease, but for more severe disease as well, according to researchers from the University of California, San Diego, School of Medicine, who published their results online, in the April edition of The Journal of Pediatrics.

“What our research found is that LBW and HBW were both associated with the severity of liver disease, but in different ways,” said Jeffrey Schwimmer, MD, professor of pediatrics, UC San Diego School of Medicine, and director of the Fatty Liver Clinic at Rady Children’s Hospital-San Diego. “Children with LBW were more likely to develop severe scarring of the liver. However, children with HBW were more likely to develop the hepatitis form of fatty liver disease.”

Historically, children at increased risk for health-related issues have been identified by both LBW and HBW, which encompasses both maternal and in utero factors, and which may also have long-term consequences for liver health.

Previous research has demonstrated a relationship between LBW and both cardiovascular disease and diabetes, but the effects and associations attached to HBW were not known.

“This is the first study to show that extremes of weights on either side of the normal spectrum are connected to an increased risk for NAFLD,” said Dr. Schwimmer. “Children who are born with LBW or HBW may merit closer attention to their metabolic health to help prevent obesity, liver disease, and diabetes.”

Dr. Schwimmer and colleagues included data from 538 children (aged less than 21 years) enrolled in the Database of the National Institute of Diabetes and Kidney Diseases NASH Clinical Research Network. All diagnoses of NAFLD were confirmed using liver biopsy.

Researchers compared birth weights in these children to those in the general US population, and assessed the severity of liver histology by birth weight category. They found that children with NAFLD compared with the general population had an overrepresentation of both LBW and HBW, with 9.3% having LBW compared with 6.1%, respectively; 75.8% having normal birth weight vs 83.5%; and 14.9% having HBW vs 10.5% (P < 0.0001).

In addition, HBW children had a significantly higher odds of having more severe steatosis (OR: 1.82; 95% CI: 1.15-2.88) and nonalcoholic steatohepatitis (OR: 2.03; 95% CI: 1.21-3.40) compared with those with normal birth weight.

Finally, Dr. Schwimmer and colleagues found that children with NAFLD and LBW had a significantly greater odds of advanced fibrosis compared with those in the general population (OR: 2.23; 95% CI: 1.08-4.62).

The Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (U01DK061718, U01DK061728, U01DK061731, U01DK061732, U01DK061734, U01DK061737, U01DK061738, U01DK061730, U01DK061713). Additional support is received from the National Center for Advancing Translational Sciences (NCATS) (UL1TR000077, UL1TR000150, UL1TR000424, UL1TR000006, UL1TR000448, UL1TR000040, UL1TR000100, UL1TR000004, UL1TR000423, UL1TR000454).