Small for gestational age is associated with an increased risk of non-alcoholic fatty liver disease (NAFLD).
Dr Valerio Nobili and colleagues from Italy investigated the correlation of birthweight with the severity of liver damage in a large cohort of children with NAFLD.
The research team evaluated 288 consecutive Caucasian Italian overweight/obese children with biopsy-proven NAFLD.
The team examined the relative association of each histological feature of NAFLD with metabolic alterations, insulin-resistance, I148M polymorphism in the patatin-like phospholipase domain-containing protein 3 (PNPLA3) gene, and birthweight relative to gestational age.
In the whole NAFLD cohort, 12% of patients were small for gestational age, 63% appropriate for gestational age, and 25% large for gestational age.
The research team found that 69% of small for gestational age children had a higher prevalence of severe steatosis, and 14% had severe portal inflammation compared with the appropriate for gestational age and large for gestational age groups.
Notably, severe steatosis was decreasing from small for gestational age to appropriate for gestational age and large for gestational age, whereas the prevalence of moderate steatosis was similar in 3 groups.
|Small for gestational age at birth increased 4-fold the likelihood of severe steatosis|
|American Journal of Gastroenterology & Hepatology|
The prevalence of type 1 NAFLD is higher in the large for gestational age group with respect to the other 2 groups, whereas the small for gestational age group shows a higher prevalence of overlap type with respect to the large for gestational age group but not compared with the appropriate for gestational age group.
The researchers found that, small for gestational age at birth increased 4-fold the likelihood of severe steatosis, and 3-fold the likelihood of NAFLD Activity Score (NAS)≥5 independently of homeostasis model assessment of insulin resistance and PNPLA3 genotype.
The PNPLA3-CC wild-type genotype was the strongest independent predictor of the absence of significant fibrosis.
Dr Nobili's team comments, "In children with NAFLD, the risk of severe steatosis is increased by small for gestational age at birth, independent of and in addition to other powerful risk factors."