title: Low Serum Potassium Levels Associated with Disease Severity in Children with Nonalcoholic Fatty Liver Disease.
abstract: OBJECTIVE
  Recent studies have suggested that decreased serum potassium level may contribute to various metabolic disorders in adult patients including nonalcoholic fatty liver disease (NAFLD). We aimed to study the correlation between serum potassium levels and the histologic severity of NAFLD in children.
  
  
  METHODS
  Pediatric patients with biopsy-proven NAFLD were included in this study. Demographic, clinical, and histopathological data were obtained. Multivariable logistic regression analysis was used to assess whether potassium levels are associated with the presence of nonalcoholic steatohepatitis (NASH) or fibrosis after adjusting for possible confounders. A p-value <0.05 was considered statistically significant.
  
  
  RESULTS
  Among 125 biopsies, 49.6% (62) had evidence of NASH while 66.4% (83) had some degree of fibrosis (stage 1-3). Mean serum potassium was significantly lower in NASH group as compared to non-NASH group (4.4±0.42 mmoL/L vs. 4.8±0.21, p<0.001). Higher potassium level had negative correlation with presence of steatosis, ballooning, lobular inflammation, fibrosis and NAFLD activity score (p<0.05). On multivariable analysis and after adjusting for the metabolic syndrome and insulin resistance, higher potassium level was significantly associated with lower likelihood of having a histological diagnosis of NASH on biopsy (odds ratio [OR], 0.12; 95% confidence interval [95% CI], 0.05-0.28; p<0.001). Similarly, the likelihood of having fibrosis decreases by 76% for every 0.5 mmoL/L increase in potassium (OR ,0.24; 95% CI, 0.11-0.54; p<0.001).
  
  
  CONCLUSIONS
  Our study shows an inverse relationship between serum potassium levels and the presence of aggressive disease (NASH and fibrosis) in children with NAFLD.
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Tabbaa
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Mina
authors.initials: M
authors.lastname: Shaker
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Bambino Gesu Children's Hospital, Rome, Italy.
authors.forename: Kazem
authors.initials: K
authors.lastname: Hoshemand
authors.affiliation: Bambino Gesu Children's Hospital, Rome, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Nobili
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Naim
authors.initials: N
authors.lastname: Alkhouri
keywords: Anatomy & histology; Fibrosis; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis; Pediatrics; Potassium