title: The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years.
abstract: OBJECTIVE
  The long-term prognosis of non-alcoholic fatty liver disease (NAFLD) in children remains uncertain. We aimed at determining the long-term outcomes and survival of children with NAFLD.
  
  
  METHODS
  Retrospective longitudinal hospital-based cohort study.
  
  
  METHODS
  Sixty-six children with NAFLD (mean age 13.9 (SD 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, dyslipidaemia and/or hyperglycaemia. Four children with baseline normal fasting glucose developed type 2 diabetes 4-11 years after NAFLD diagnosis. A total of 13 liver biopsies were obtained from five patients over a mean of 41.4 (SD 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 standardised mortality ratio of 13.6 (95% confidence interval, 3.8 to 34.8). NAFLD recurred in the allograft in the two cases transplanted, with one patient 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 centre may be associated with a significantly shorter survival as compared to the general population.
authors.affiliation: Department of Pediatric and Adolescent Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Feldstein
authors.forename: P
authors.initials: P
authors.lastname: Charatcharoenwitthaya
authors.forename: S
authors.initials: S
authors.lastname: Treeprasertsuk
authors.forename: J T
authors.initials: JT
authors.lastname: Benson
authors.forename: F B
authors.initials: FB
authors.lastname: Enders
authors.forename: P
authors.initials: P
authors.lastname: Angulo
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000209:etiology; D042241:Early Diagnosis; D004812:Epidemiologic Methods; D005234:Fatty Liver / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000209:etiology; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology; D011379:Prognosis; D016019:Survival Analysis