title: Non-alcoholic fatty liver disease is associated with early left ventricular dysfunction in childhood acute lymphoblastic leukaemia survivors.
abstract: BACKGROUND
  Childhood acute lymphoblastic leukaemia (ALL) survivors have an increased risk of metabolic and cardiovascular disease. We aimed to assess the presence of non-alcoholic fatty liver disease (NAFLD) in childhood ALL and if it is associated with early cardiovascular dysfunction.
  
  
  METHODS
  In total, 53 childhood ALL survivors and 34 controls underwent auxological evaluation, biochemical assay, liver, heart and vascular ultrasound study.
  
  
  RESULTS
  NAFLD was more frequent in ALL patients than in controls (39.6% vs 11.7%, P < 0.01). Patients with NAFLD were more obese and insulin resistant than patients without NAFLD. Flow-mediated dilatation and interventricular septum were lower in the ALL group than those in the control group (P < 0.001 for both). The patients with NAFLD showed lower left ventricular ejection fraction than those without NAFLD (P = 0.011). In ALL survivors, BMI-SDS and subcutaneous fat were the strongest predictors of NAFLD, whereas preperitoneal adipose tissue and C-reactive protein were the strongest predictors of left ventricular ejection fraction.
  
  
  CONCLUSIONS
  Childhood ALL survivors had higher prevalence of NAFLD than healthy controls, which is associated with early left ventricular impairment. In the case of fatty liver, a comprehensive heart evaluation is mandatory. We strongly recommend to prevent visceral adiposity in ALL survivors, to search for metabolic syndrome or its components and to reinforce the need of intervention on diet and lifestyle during the follow-up of these patients.
authors.affiliation: Department of Biomedicine and Human OncologyPediatric Section, University 'A. Moro' of Bari, Bari, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Delvecchio
authors.affiliation: Department of Biomedicine and Human OncologyPediatric Section, University 'A. Moro' of Bari, Bari, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Muggeo
authors.affiliation: Department of Diagnostic ImagingUniversity of Bari 'A. Moro', Bari, Italy.
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Monteduro
authors.affiliation: Department of Biomedicine and Human OncologyPediatric Section, University 'A. Moro' of Bari, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lassandro
authors.affiliation: Department of Biomedicine and Human OncologyPediatric Section, University 'A. Moro' of Bari, Bari, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Novielli
authors.affiliation: Department of Emergency and Organ Transplantation (DETO)Cardiovascular Diseases Section, University 'A. Moro' of Bari, Bari, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Valente
authors.affiliation: Department of Diagnostic ImagingUniversity of Bari 'A. Moro', Bari, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Salinaro
authors.affiliation: Department of Emergency and Organ Transplantation (DETO)Cardiovascular Diseases Section, University 'A. Moro' of Bari, Bari, Italy.
authors.forename: Annapaola
authors.initials: A
authors.lastname: Zito
authors.affiliation: Department of Emergency and Organ Transplantation (DETO)Cardiovascular Diseases Section, University 'A. Moro' of Bari, Bari, Italy.
authors.forename: Marco Matteo
authors.initials: MM
authors.lastname: Ciccone
authors.affiliation: Department of Biomedicine and Human OncologyPediatric Section, University 'A. Moro' of Bari, Bari, Italy.
authors.forename: Vito Leonardo
authors.initials: VL
authors.lastname: Miniello
authors.affiliation: Department of Biomedicine and Human OncologyPediatric Section, University 'A. Moro' of Bari, Bari, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Santoro
authors.affiliation: Department of Biomedicine and Human OncologyPediatric Section, University 'A. Moro' of Bari, Bari, Italy paola.giordano@uniba.it.
authors.forename: Paola
authors.initials: P
authors.lastname: Giordano
authors.affiliation: Department of Biomedicine and Human OncologyPediatric Section, University 'A. Moro' of Bari, Bari, Italy.
authors.forename: Maria Felicia
authors.initials: MF
authors.lastname: Faienza
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology