title: Association between puberty and features of nonalcoholic fatty liver disease.
abstract: OBJECTIVE
  Physiological changes that occur during puberty might affect pathologic features of nonalcoholic fatty liver disease (NAFLD). We investigated associations between pubertal development and clinical and histopathologic features of NAFLD.
  
  
  METHODS
  We studied 186 children (age <18 years, 143 boys) with biopsy-proven NAFLD. The population was divided into 3 groups on the basis of Tanner stage (prepuberty, puberty, and postpuberty). Clinical characteristics and histologic features were compared among groups. Multivariable regression models were used to adjust for potential confounders.
  
  
  RESULTS
  After adjusting for other factors, hyperuricemia and low levels of high-density-lipoprotein cholesterol were more prevalent among children who entered puberty with lower levels of quantitative insulin sensitivity check index (P < .05). The degree of steatosis, numbers of Mallory-Denk bodies, and diagnostic categories of NAFLD differed among groups (P < .05). There were potential sex differences in associations between stages of puberty and lobular inflammation, hepatocyte ballooning, and borderline steatohepatitis of zone 3; these were therefore not included in multivariable analyses of the overall population. After adjustment for different sets of confounders, patients at or beyond puberty were less likely to have high-grade steatosis, severe portal inflammation, borderline steatohepatitis (zone 1), or a high stage of fibrosis than patients who had not entered puberty (P < .05). On the contrary, the prevalence of Mallory-Denk body was greater among postpuberty subjects (P = .06).
  
  
  CONCLUSIONS
  Steatosis, portal inflammation, and fibrosis are less severe during or after puberty than before puberty among subjects with NAFLD. Postpubescent individuals have a lower prevalence of borderline steatohepatitis of zone 1 but are more likely to have Mallory-Denk bodies. These findings indicate that puberty affects the pathologic features of NAFLD.
authors.affiliation: Division of Gastroenterology, Duke University, Durham, NC 27710, USA. ayako.suzuki@duke.edu
authors.forename: Ayako
authors.initials: A
authors.lastname: Suzuki
authors.forename: Manal F
authors.initials: MF
authors.lastname: Abdelmalek
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Schwimmer
authors.forename: Joel E
authors.initials: JE
authors.lastname: Lavine
authors.forename: Ann O
authors.initials: AO
authors.lastname: Scheimann
authors.forename: Aynur
authors.initials: A
authors.lastname: Unalp-Arida
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Yates
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Sanyal
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Guy
authors.forename: Anna Mae
authors.initials: AM
authors.lastname: Diehl
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000473:pathology*; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008103:Liver Cirrhosis / Q000473:pathology; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease; D011627:Puberty