Relations of steatosis type, grade, and zonality to histological features in pediatric nonalcoholic fatty liver disease.
BACKGROUND
The relations between hepatic steatosis and histological features of hepatocyte injury in children with nonalcoholic fatty liver disease have yet to be examined. The aims of the present study were to establish associations between steatosis amount, type, and distribution in a well-characterized group of children with biopsy-proven nonalcoholic fatty liver disease (NAFLD).


METHODS
One hundred eight children with NAFLD seen in 5 centers were studied. Clinical and laboratory data were collected. Hematoxylin-eosin and Masson trichrome stains were evaluated by 2 expert liver pathologists. Steatosis grade (0-3), type (macrovesicular, microvesicular, or mixed), and zone (1, 3, azonal, or panacinar) were determined. The NAFLD activity score and fibrosis stage were determined.


RESULTS
Median patient age was 12 years and median body mass index was 31 kg/m. Fibrosis was present in 87%. The median NAFLD activity score was 4. Mild, moderate, and severe steatosis were present in 42%, 34%, and 24% of biopsies, respectively. Macrovesicular steatosis was present in 81% and mixed steatosis was present in 19%. Panacinar distribution of steatosis was most frequent (40%), followed by azonal (27%). Steatosis grade positively correlated with portal inflammation (P = 0.018). Azonal distribution positively correlated with presence of hepatocyte ballooning (P = 0.03). Biopsies with mixed steatosis were approximately 20 times more likely to have megamitochondria than those with macrovesicular steatosis alone (95% confidence interval 2.3-204.9). There was no relation between steatosis amount, type, or distribution to fibrosis stage.


CONCLUSIONS
Specific histological patterns of steatosis in children are associated with histological markers of steatohepatitis. Ballooning and portal inflammation correlated well with features of steatosis.
Department of Pathology, Cleveland Clinic, USA. carterc@ccf.org
Christine
C
Carter-Kent
Elizabeth M
EM
Brunt
Lisa M
LM
Yerian
Naim
N
Alkhouri
Paul
P
Angulo
Rohit
R
Kohli
Simon C
SC
Ling
Stavra A
SA
Xanthakos
Peter F
PF
Whitington
Phunchai
P
Charatcharoenwitthaya
Jason
J
Yap
Rocio
R
Lopez
Arthur J
AJ
McCullough
Ariel E
AE
Feldstein
D000293:Adolescent; D001706:Biopsy; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005234:Fatty Liver / Q000145:classification / Q000150:complications / Q000473:pathology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000473:pathology; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric