title: The full spectrum of hepatic steatosis in children.
abstract: OBJECTIVE
  We aim to identify the spectrum of etiologies of steatosis in pediatric liver biopsies.
  
  
  METHODS
  Information was collected from 155 children with steatosis on liver biopsy, including anthropometrics, laboratory, and radiologic data. Biopsies were reviewed by a liver pathologist.
  
  
  RESULTS
  The 4 major diagnoses associated with hepatic steatosis were nonalcoholic fatty liver disease (37%), metabolic disease (9%), oncologic disease (8%) and viral hepatitis (7%). Patients with nonalcoholic fatty liver disease were older (P = .0001) and more likely to have a body mass index z score >2 (P < .0001). Patients with a metabolic diagnosis were younger (P = .0002). Radiologic imaging of the liver yielded normal results in 44 of 108 of children (30%); 7 of these had >66% macrovesicular fatty change on biopsy, and 3 had severe fibrosis/cirrhosis.
  
  
  CONCLUSIONS
  The range of causes of steatosis in pediatric liver biopsies is broad. Not all patients, even with advanced liver disease, had abnormalities with liver imaging, emphasizing the role for liver biopsy in certain cases.
authors.affiliation: Division of Pediatric Gastroenterology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA Division of Pediatric Gastroenterology, Pediatric Specialists of Virginia, Fairfax, VA, USA suchihourigan@gmail.com.
authors.forename: Suchitra K
authors.initials: SK
authors.lastname: Hourigan
authors.affiliation: Department of Pathology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Torbenson
authors.affiliation: Division of Pediatric Gastroenterology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Tibesar
authors.affiliation: Division of Pediatric Gastroenterology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Ann O
authors.initials: AO
authors.lastname: Scheimann
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005234:Fatty Liver / Q000209:etiology* / Q000473:pathology; D005260:Female; D006525:Hepatitis, Viral, Human / Q000150:complications*; D006801:Humans; D007223:Infant; D008099:Liver / Q000473:pathology; D008297:Male; D008659:Metabolic Diseases / Q000150:complications*; D009369:Neoplasms / Q000150:complications*; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: children; liver steatosis; nonalcoholic fatty liver disease; obesity; pediatrics