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Kalveram L, Baumann U, De Bruyne R, Draijer L, Janczyk W, Kelly D, Koot BG, Lacaille F, Lefere S, Lev HM, Lubrecht J, Mann JP, Mosca A, Rajwal S, Socha P, Vreugdenhil A, Alisi A, Hudert CA. Noninvasive scores are poorly predictive of histological fibrosis in paediatric fatty liver disease. J Pediatr Gastroenterol Nutr 2024; 78:27-35. [PMID: 38291699 DOI: 10.1002/jpn3.12068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/01/2023] [Accepted: 10/25/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVES Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children. Roughly a quarter of paediatric patients with NAFLD develop nonalcoholic steatohepatitis and fibrosis. Here, we evaluated the diagnostic accuracy of previously published noninvasive fibrosis scores to predict liver fibrosis in a large European cohort of paediatric patients with NAFLD. METHODS The 457 patients with biopsy-proven NAFLD from 10 specialized centers were included. We assessed diagnostic accuracy for the prediction of any (F ≥ 1), moderate (F ≥ 2) or advanced (F ≥ 3) fibrosis for the AST/platelet ratio (APRI), Fibrosis 4 score (FIB-4), paediatric NAFLD fibrosis score (PNFS) and paediatric NAFLD fibrosis index (PNFI). RESULTS Patients covered the full spectrum of fibrosis (F0: n = 103; F1: n = 230; F2: n = 78; F3: n = 44; F4: n = 2). None of the scores were able to accurately distinguish the presence of any fibrosis from no fibrosis. For the detection of moderate fibrosis, area under the receiver operating characteristic curve (AUROC) were: APRI: 0.697, FIB-4: 0.663, PNFI: 0.515, PNFS: 0.665, while for detection of advanced fibrosis AUROCs were: APRI: 0.759, FIB-4: 0.611, PNFI: 0.521, PNFS: 0.712. Fibrosis scores showed no diagnostic benefit over using ALT ≤ 50/ > 50 IU/L as a cut-off. CONCLUSIONS Established fibrosis scores lack diagnostic accuracy to replace liver biopsy for staging of fibrosis, giving similar results as compared to using ALT alone. New diagnostic tools are needed for Noninvasive risk-stratification in paediatric NAFLD.
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Affiliation(s)
- Laura Kalveram
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität zu Berlin and Humboldt-Universität zu, Berlin, Germany
| | - Ulrich Baumann
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver, and Metabolic Diseases Hannover, Hannover Medical School, Hanover, Germany
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Ruth De Bruyne
- Pediatric Gastroenterology, Hepatology and Nutrition, Ghent University, Ghent, Belgium
| | - Laura Draijer
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Netherlands
| | - Wojciech Janczyk
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Paediatrics, Children's Memorial Health Institute, Warsaw, Poland
| | - Deirdre Kelly
- Liver unit, Birmingham Children's Hospital, University of Birmingham, Birmingham, UK
| | - Bart G Koot
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Netherlands
| | - Florence Lacaille
- Gastroenterology-Hepatology-Nutrition Unit, Hôpital Universitaire Necker-Enfants maladies, Paris, France
| | - Sander Lefere
- Hepatology Research Unit, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Hadar Moran Lev
- Pediatric Gastroenterology Unit, Dana Dwek Children's Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Judith Lubrecht
- Department of Pediatrics, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jake P Mann
- Liver unit, Birmingham Children's Hospital, University of Birmingham, Birmingham, UK
| | - Antonella Mosca
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Sanjay Rajwal
- Children's Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds Children's Hospital, Leeds, UK
| | - Piotr Socha
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Paediatrics, Children's Memorial Health Institute, Warsaw, Poland
| | - Anita Vreugdenhil
- Department of Pediatrics, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Anna Alisi
- Genetics of Complex Phenotypes Research Unit, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Christian A Hudert
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität zu Berlin and Humboldt-Universität zu, Berlin, Germany
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Socha P, Czlonkowska A, Janczyk W, Litwin T. Wilson's disease- management and long term outcomes. Best Pract Res Clin Gastroenterol 2021; 56-57:101768. [PMID: 35331405 DOI: 10.1016/j.bpg.2021.101768] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/01/2021] [Accepted: 10/08/2021] [Indexed: 01/31/2023]
Abstract
Wilson's disease (WD) is an autosomal recessive genetic disorder of copper metabolism leading to liver or brain injury due to accumulation of copper. Diagnosis is based on: clinical features, biochemical tests including plasma ceruloplasmin concentration, 24h urinary copper excretion, copper content in the liver, and molecular analysis. Pharmacological therapy comprises chelating agents (penicillamine, trientine) and zinc salts which seem to be very effective. Still, poor compliance is a major problem. Adolescents and patients with psychiatric disorders usually have problems with adherence to treatment. As transition is a vulnerable period transition ''training'' should start before the planned transfer, preferably already in early adolescence in cooperation between adult and pediatric clinics. Response to treatment is assessed based on physical examination, normal liver function tests and monitoring of copper metabolism markers. Liver transplantation has a well-defined role in Wilsonian acute hepatic failure according to the prognostic score. The long-term survival in WD patients seems to be very similar as for the general population if disease is early diagnosed and correctly treated. WD patients with a longer delay from diagnosis to therapy and who present with neurological and psychiatric symptoms have worse quality of life.
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Affiliation(s)
- Piotr Socha
- The Children's Memorial Health Institute, Warsaw, Poland.
| | | | | | - Tomasz Litwin
- Institute of Psychiatry and Neurology, Warsaw, Poland
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Kulecka M, Wierzbicka A, Paziewska A, Mikula M, Habior A, Janczyk W, Dabrowska M, Karczmarski J, Lazniewski M, Ginalski K, Czlonkowska A, Socha P, Ostrowski J. A heterozygous mutation in GOT1 is associated with familial macro-aspartate aminotransferase. J Hepatol 2017; 67:1026-1030. [PMID: 28716744 DOI: 10.1016/j.jhep.2017.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/16/2017] [Accepted: 07/01/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Macro-aspartate aminotransferase (macro-AST) manifests as a persistent elevation of AST levels, because of association of the protein with immunoglobulins in the circulation. Macro-AST is a rare, benign condition without a previously confirmed genetic basis. METHODS Whole exome sequencing (WES)-based screening was performed on 32 participants with suspected familial macro-AST, while validation of variants was performed on an extended cohort of 92 probands and 1,644 healthy controls using Taqman genotyping. RESULTS A missense variant (p.Gln208Glu, rs374966349) in glutamate oxaloacetate transaminase 1 (GOT1) was found, as a putative causal variant predisposing to familial macro-AST. The GOT1 p.Gln208Glu mutation was detected in 50 (54.3%) of 92 probands from 20 of 29 (69%) families, while its prevalence in healthy controls was only 0.18%. In silico analysis demonstrated that the amino acid at this position is not conserved among different species and that, functionally, a negatively charged glutamate on the GOT1 surface could strongly anchor serum immunoglobulins. CONCLUSIONS Our data highlight that testing for the p.Gln208Glu genetic variant may be useful in diagnosis of macro-AST. LAY SUMMARY Higher than normal levels of aspartate aminotransferase (AST) in the bloodstream may be a sign of a health problem. Individuals with macro-AST have elevated blood AST levels, without ongoing disease and often undergo unnecessary medical tests before the diagnosis of macro-AST is established. We found a genetic variant in the GOT1 gene associated with macro-AST. Genetic testing for this variant may aid diagnosis of macro-AST.
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Affiliation(s)
- Maria Kulecka
- Department of Gastroenterology and Hepatology, Medical Center for Postgraduate Education, Warsaw 01-813, Poland
| | - Aldona Wierzbicka
- Department of Biochemistry, Radioimmunology and Experimental Medicine, Children's Memorial Health Institute, Warsaw 04-730, Poland
| | - Agnieszka Paziewska
- Department of Gastroenterology and Hepatology, Medical Center for Postgraduate Education, Warsaw 01-813, Poland
| | - Michal Mikula
- Department of Genetics, Cancer Center-Institute, Warsaw 02-781, Poland
| | - Andrzej Habior
- Department of Gastroenterology and Hepatology, Medical Center for Postgraduate Education, Warsaw 01-813, Poland
| | - Wojciech Janczyk
- Department of Gastroenterology, Hepatology and Feeding Disorders, Children's Memorial Health Institute, Warsaw 04-730, Poland
| | | | - Jakub Karczmarski
- Department of Genetics, Cancer Center-Institute, Warsaw 02-781, Poland
| | - Michal Lazniewski
- Laboratory of Bioinformatics and Systems Biology, Centre of New Technologies, University of Warsaw, Warsaw 02-089, Poland; Department of Physical Chemistry, Faculty of Pharmacy, Medical University of Warsaw, Warsaw 02-097, Poland
| | - Krzysztof Ginalski
- Laboratory of Bioinformatics and Systems Biology, Centre of New Technologies, University of Warsaw, Warsaw 02-089, Poland
| | - Anna Czlonkowska
- Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Piotr Socha
- Department of Gastroenterology, Hepatology and Feeding Disorders, Children's Memorial Health Institute, Warsaw 04-730, Poland.
| | - Jerzy Ostrowski
- Department of Gastroenterology and Hepatology, Medical Center for Postgraduate Education, Warsaw 01-813, Poland; Department of Genetics, Cancer Center-Institute, Warsaw 02-781, Poland.
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Krawczyk M, Kaminska D, Janczyk W, Lammert F, Socha P. Biopsy-based analysis of the prosteatotic TM6SF2 p.E167K and PNPLA3 p.I148 M gene variants as potential modifiers of Wilson disease. Z Gastroenterol 2016. [DOI: 10.1055/s-0036-1597350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M Krawczyk
- Saarland University, Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - D Kaminska
- The Children's Memorial Health Institute, Department of Gastroenterology, Hepatology and Nutrition Disorders, Warsaw, Poland
| | - W Janczyk
- The Children's Memorial Health Institute, Department of Gastroenterology, Hepatology and Nutrition Disorders, Warsaw, Poland
| | - F Lammert
- Saarland University, Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - P Socha
- The Children's Memorial Health Institute, Department of Gastroenterology, Hepatology and Nutrition Disorders, Warsaw, Poland
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Zmyslowska A, Borowiec M, Antosik K, Ploski R, Ciechanowska M, Iwaniszewska B, Jakubiuk-Tomaszuk A, Janczyk W, Krawczynski M, Salmonowicz B, Stelmach M, Mlynarski W. Genetic evaluation of patients with Alström syndrome in the Polish population. Clin Genet 2015; 89:448-453. [PMID: 26283575 DOI: 10.1111/cge.12656] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 07/15/2015] [Accepted: 07/15/2015] [Indexed: 12/21/2022]
Abstract
Alström syndrome (AS) is a rare syndromic form of obesity and type 2 diabetes (T2D) in children coexisting with retinal dystrophy and disorders of many organs caused by the mutations in ALMS1 gene. Aim of this study was to identify the causative mutations in ALMS1 in a group of 12 patients of Polish origin with clinical symptoms of AS, and their 21 first-degree relatives. Using DNA sequencing, nine different mutations including three novel were identified. These mutations were not present in 212 Polish individuals with no symptoms of AS, subjected to whole-exome sequencing and collected in a national registry. Looking for genotype-phenotype relationships, we confirmed a severe phenotype in a boy with homozygous mutation in exon 16, and a relationship between a presence of T2D and mutations in exon 19. Evaluation of the type of mutation and its clinical effects gives hope for earlier diagnosis of AS in future patients and more advanced therapeutic approaches for patients with already diagnosed AS.
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Affiliation(s)
- A Zmyslowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Lodz, Poland
| | - M Borowiec
- Department of Clinical Genetics, Medical University of Lodz, Lodz, Poland
| | - K Antosik
- Department of Clinical Genetics, Medical University of Lodz, Lodz, Poland
| | - R Ploski
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland
| | - M Ciechanowska
- Department of Endocrinology for Children and Adolescents, Jagiellonian University, Cracow, Poland
| | - B Iwaniszewska
- Department of Pediatrics, Endocrinology and Neurology, Children's hospital, Torun, Poland
| | | | - W Janczyk
- Department of Gastroenterology, Hepatology, Nutrition Disorders and Pediatrics, Warsaw, Poland
| | - M Krawczynski
- Department of Clinical Genetics, Medical University of Poznan, Poznan, Poland
| | - B Salmonowicz
- Department of Pediatric Endocrinology, Wroclaw Medical University, Wroclaw, Poland
| | - M Stelmach
- Department of Endocrinology for Children and Adolescents, Jagiellonian University, Cracow, Poland
| | - W Mlynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Lodz, Poland
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Janczyk W, Lebensztejn D, Wierzbicka-Rucińska A, Mazur A, Neuhoff-Murawska J, Matusik P, Socha P. Omega-3 Fatty acids therapy in children with nonalcoholic Fatty liver disease: a randomized controlled trial. J Pediatr 2015; 166:1358-63.e1-3. [PMID: 25771388 DOI: 10.1016/j.jpeds.2015.01.056] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/09/2014] [Accepted: 01/30/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of omega-3 fatty acid supplementation in children with nonalcoholic fatty liver disease (NAFLD). STUDY DESIGN Overweight/obese children with NAFLD (n = 76; median age, 13 years; IQR, 11.1-15.2 years) were eligible to participate in the study. The diagnosis of NAFLD was based on elevated alanine aminotransferase (ALT) to ≥ 30% of the upper limit of normal (ULN) and liver hyperechogenicity on ultrasound. Patients were randomized to receive omega-3 fatty acids (docosahexaenoic acid and eicosapentaenoic acid, 450-1300 mg/day) or placebo (omega-6 sunflower oil). The primary outcome was the number of patients who demonstrated decreased ALT activity by ≥ 0.3 times the ULN. Secondary outcomes included alterations in liver function tests, liver hyperechogenicity, insulin resistance, and other metabolic markers after 6 months of intervention. RESULTS Out of 76 enrolled patients, 64 completed the trial and were analyzed. After 6 months, we found no significant differences between the omega-3 and placebo groups in the number of patients with decreased ALT by ≥ 0.3 times the ULN (24 vs 23) or in median (IQR) ALT activity (48.5 [31-62] U/L vs 39 [27-55] U/L), liver hyperechogenicity, insulin resistance, or serum lipid levels. However, patients in the omega-3 group had lower levels of aspartate aminotransferase (28 [25-36] U/L vs 39 [27-55] U/L; P = .04) and gamma-glutamyl transpeptidase (26 [17.5-36.5] U/L vs 35 [22-52] U/L; P = .04), and significantly higher levels of adiponectin. CONCLUSION Omega-3 fatty acid supplementation did not increase the number of patients with decreased ALT levels and it did not affect liver steatosis on ultrasound, but it improved aspartate aminotransferase and gamma-glutamyl transpeptidase levels in children with NAFLD compared with placebo. TRIAL REGISTRATION Registered with ClinicalTrials.gov: NCT01547910.
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Affiliation(s)
- Wojciech Janczyk
- Department of Gastroenterology, Hepatology and Nutrition Disorders, The Children's Memorial Health Institute, Warsaw, Poland
| | - Dariusz Lebensztejn
- Department of Pediatrics, Gastroenterology, and Allergology, Medical University of Bialystok, Bialystok, Poland
| | - Aldona Wierzbicka-Rucińska
- Department of Biochemistry and Radioimmunology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Artur Mazur
- Medical Faculty, University of Rzeszow, Rzeszow, Poland
| | - Joanna Neuhoff-Murawska
- Department of Gastroenterology, Hepatology and Nutrition Disorders, The Children's Memorial Health Institute, Warsaw, Poland
| | - Paweł Matusik
- Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical University of Silesia, Katowice, Poland
| | - Piotr Socha
- Department of Gastroenterology, Hepatology and Nutrition Disorders, The Children's Memorial Health Institute, Warsaw, Poland.
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Janczyk W, de Roo JHC, Schweizer J, Socha J, Socha P, Mearin ML. Coeliac disease not responding to a gluten-free diet in children: case studies and literature review. Dev Period Med 2015; 19:162-166. [PMID: 26384116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We presented the cases of three children with coeliac disease who despite good adherence to a glutenfree diet remained non-responsive to treatment. Two patients, one of them with IgA deficiency, were successfully treated by complete gluten exclusion with enteral nutrition. However the third child with a severe coeliac disease did not achieve clinical and histologic improvement, even on immunosuppressive treatment. If no hidden sources of gluten can be identified, other causes of persistent villous atrophy, dierent from coeliac disease, have to be considered. They include e.g. inflammatory, immune and endocrine diseases of the digestive tract. In severe cases of childhood coeliac disease not responding to a gluten free diet, autoimmune enteropathy and refractory coeliac disease must be taken into account.
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Affiliation(s)
- Wojciech Janczyk
- Department of Gastroenterology, Hepatology and Eating Disorders, The Children's Memorial Health Institute, Warsaw, Poland
| | - J H C de Roo
- Department of Pediatrics Leiden University Medical Center, The Netherlands
| | - Joachim Schweizer
- Department of Pediatrics Leiden University Medical Center, The Netherlands
| | - Jerzy Socha
- Department of Gastroenterology, Hepatology and Eating Disorders, The Children's Memorial Health Institute, Warsaw, Poland
| | - Piotr Socha
- Department of Gastroenterology, Hepatology and Eating Disorders, The Children's Memorial Health Institute, Warsaw, Poland
| | - M Luisa Mearin
- Department of Pediatrics Leiden University Medical Center, The Netherlands
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Janczyk W, Socha P, Lebensztejn D, Wierzbicka A, Mazur A, Neuhoff-Murawska J, Matusik P. Omega-3 fatty acids for treatment of non-alcoholic fatty liver disease: design and rationale of randomized controlled trial. BMC Pediatr 2013; 13:85. [PMID: 23702094 PMCID: PMC3672084 DOI: 10.1186/1471-2431-13-85] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 05/07/2013] [Indexed: 12/16/2022] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is a liver manifestation of metabolic syndrome since obesity and insulin resistance are the main pathogenic contributors for both conditions. NAFLD carries increased risk of atherosclerosis and cardiovascular diseases. There is an urgent need to find effective and safe therapy for children and adults with NAFLD. Data from research and clinical studies suggest that omega-3 fatty acids may be beneficial in metabolic syndrome-related conditions and can reduce the risk of cardiovascular disease. Methods/design We are conducting a randomized, multicenter, double-blind, placebo-controlled trial of treatment with omega-3 fatty acids in children with NAFLD. Patients are randomized to receive either omega-3 fatty acids containing docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) or placebo for 24 weeks. The dose of omega-3 (DHA+ EPA) ranges from 450 to 1300 mg daily. Low calorie diet and increased physical activity are advised and monitored using validated questionnaires. The primary outcome of the trial is the number of patients who decreased ALT activity by ≥ 0,3 of upper limit of normal. The main secondary outcomes are improvement in the laboratory liver tests, liver steatosis on ultrasound, markers of insulin resistance and difference in fat/lean body mass composition after 6 months of intervention. Discussion Potential efficacy of omega-3 fatty acids in the treatment of NAFLD will provide needed rationale for use of this safe diet supplement together with weight reduction therapy in the growing population of children with NAFLD. Trial registration NCT01547910
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Affiliation(s)
- Wojciech Janczyk
- Department Gastroenterology, Hepatology and Eating Disorders, Children's Memorial Health Institute, Warsaw, Poland.
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Abstract
Non-alcoholic fatty liver disease is increasingly prevalent in children, together with obesity. Transaminases, tests for insulin resistance, ultrasonography and MRI are variably used as surrogates markers of steatosis. Other liver diseases, such as Wilson disease, should be excluded. A liver biopsy is performed in selected cases: young children, familial history of severe disease, inconclusive tests for other pathologies, suspected advanced fibrosis, hypertransaminasemia despite weight loss and in clinical trials. Weight reduction, and changes in lifestyle, are the front-line treatment. Drug therapy is under evaluation.
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Affiliation(s)
- Wojciech Janczyk
- Department of Gastroenterology, Hepatology and Eating Disorders, The Children's Memorial Health Institute, Warsaw, Poland.
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Socha P, Ryzko J, Janczyk W, Dzik E, Iwanczak B, Krzesiek E. Hepatic vein thrombosis as a complication of ulcerative colitis in a 12-year-old patient. Dig Dis Sci 2007; 52:1293-8. [PMID: 17372822 DOI: 10.1007/s10620-006-9503-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 06/26/2006] [Indexed: 01/28/2023]
Affiliation(s)
- Piotr Socha
- Department of Gastroenterology, Hepatology and Immunology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730, Warsaw, Poland
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