title: The changing face of hepatitis in boys with haemophilia associated with increased prevalence of obesity.
abstract: Hepatitis in children with haemophilia was historically most often associated with transfusion-transmitted infections. However, with the use of recombinant clotting factor concentrates, acquisition of such infections has now become rare. We studied the profile of hepatitis in North-American children with haemophilia in the modern era of safe blood products and excess childhood obesity. A total of 173 boys (<18 years) registered in the Pediatric Comprehensive Care Haemophilia Program were included in this retrospective study. Hospital records were reviewed for baseline data, serial height and weight measurements and serial alanine aminotransferase (ALT) levels. A body mass index (BMI) ranking was available for 170 boys, of whom 25 (14.7%, 95% CI 9.7-20.9%) were obese. The rate of obesity was higher in severe haemophilic boys. Compared with the general childhood population, the rate of obesity trended towards being higher in young haemophilic boys (2-5 years), but was similar in other age groups. A persistently high ALT (≥80 U L(-1) ) was documented in 5 boys and was associated with obesity. Three boys had clinical and imaging studies compatible with non-alcoholic fatty liver disease (NAFLD). Overweight and obesity are common among haemophilic boys, especially those who are younger and with severe disease. In this large group of haemophilic boys, chronic viral hepatitis was rare and NAFLD was a more common cause of liver disease. Overweight and obese haemophilic boys should be evaluated for NAFLD and interventional programmes should be designed to reduce the potential complications associated with obesity.
authors.affiliation: Department of Nursing, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Revel-Vilk
authors.forename: P
authors.initials: P
authors.lastname: Komvilaisak
authors.forename: V
authors.initials: V
authors.lastname: Blanchette
authors.forename: A M
authors.initials: AM
authors.lastname: Stain
authors.forename: G
authors.initials: G
authors.lastname: Floros
authors.forename: A
authors.initials: A
authors.lastname: Cochrane
authors.forename: C
authors.initials: C
authors.lastname: Blanchette
authors.forename: M
authors.initials: M
authors.lastname: Hang
authors.forename: E A
authors.initials: EA
authors.lastname: Roberts
authors.forename: S C
authors.initials: SC
authors.lastname: Ling
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005234:Fatty Liver / Q000453:epidemiology; D006467:Hemophilia A / Q000150:complications* / Q000201:enzymology / Q000503:physiopathology; D002836:Hemophilia B / Q000150:complications* / Q000201:enzymology / Q000503:physiopathology; D006505:Hepatitis / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease; D009656:North America / Q000453:epidemiology; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies
chemical_list: D000410:Alanine Transaminase