title: Non-high-density lipoprotein cholesterol (non-HDL-C) levels in children with nonalcoholic fatty liver disease (NAFLD).
abstract: Non-alcoholic fatty liver disease (NAFLD) is associated with increased cardiovascular disease (CVD) risk in children. Non-high density lipoprotein-cholesterol (non-HDL-C) has been shown to be a good predictor of cardiovascular events. Recent data in adults found non-alcoholic steatohepatitis (NASH) to be associated with significantly higher levels of non-HDL-C than simple steatosis, suggestive it might be used as a non-invasive tool to diagnose NASH. The goal of our study was to assess non-HDL-C levels in children with NAFLD. Our cohort consisted of pediatric patients with biopsy-proven NAFLD. Anthropometric, laboratory, and histologic data were obtained on all patients. Univariable analysis was performed to assess differences in clinical characteristics between groups. Spearman rank correlation coefficients were calculated to assess the correlation between non-HDL-C levels and clinical variables. ANCOVA was used to adjust for possible confounders. 302 subjects with NAFLD were included in our study; 203 with NASH and 99 without NASH. Subjects with NASH had significantly higher non-HDL-C levels than those without (p = 0.004). Histologic features of NASH, including ballooning, inflammation, and fibrosis were found to be weakly correlated with non-HDL-C levels, (p < 0.05 for all). After adjusting for the presence of metabolic syndrome (MetS), ALT, and GGT, the association between non-HDL-C and NASH was not significant (p = 0.66). In Conclusion, non-HDL-C levels are higher in children with NASH than those with simple steatosis, suggesting increased CVD risk. This may be a reflection of the higher prevalence of MetS. Non-HDL-C had a positive association with histologic features of NASH.
authors.affiliation: Department of Pediatric Gastroenterology, Cleveland Clinic, 9500 Euclid Avenue, A111, Cleveland, OH 44195 USA ; Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, A51, Cleveland, OH 44195 USA.
authors.forename: Naim
authors.initials: N
authors.lastname: Alkhouri
authors.affiliation: Department of Pediatric Gastroenterology, Cleveland Clinic, 9500 Euclid Avenue, A111, Cleveland, OH 44195 USA.
authors.forename: Katharien
authors.initials: K
authors.lastname: Eng
authors.affiliation: Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195 USA.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Liver Unit, Bambino Gesù Children's Hospital and Research Institute, 37 Salita di Sant'onofrio, 00165 Rome, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Nobili
keywords: Atherosclerosis; Cardiovascular disease risk; Children; Histology; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis; Non-high-density lipoprotein cholesterol