UCSD. US: Study finds higher risk for nonalcoholic fatty liver disease, hypertension and heart problems
High blood pressure and nonalcoholic fatty liver disease
(NAFLD) are two emerging health problems related to the epidemic of
childhood obesity. In a recent study, researchers at University of
California, San Diego School of Medicine sought to determine the
prevalence of high blood pressure in children with NAFLD, which places
them at risk for premature cardiovascular disease.
The study, published in the November 24 edition of PLOS ONE, found that children with NAFLD are at substantial risk for high blood pressure, which is commonly undiagnosed.
“As a result of our study, we recommend that blood pressure
evaluation, control and monitoring should be included as an integral
component of the clinical management of children with NAFLD, especially
because this patient population is at greater risk for heart attacks and
strokes,” said Jeffrey Schwimmer, MD, in the Department of Pediatrics
at UC San Diego School of Medicine and principal investigator of the
study. “Hypertension is a main cause of preventable death and disability
in the United States in adults, but much of the origin occurs in
childhood.”
NAFLD – the inappropriate storage of fat droplets inside liver cells –
is the most common cause of chronic liver disease in the United States
and affects nearly 10 percent of all children. Although children with
chronic liver disease often have no symptoms, some children with NAFLD
will have fatigue and/or abdominal pain. The initial evaluation for
NAFLD is via a blood test and diagnosis is ultimately based upon a liver
biopsy. The disease is most common in children and teenagers who are
overweight and can develop in conjunction with other health problems,
such as diabetes.
The study, conducted by the National Institutes of Health
Nonalcoholic Steatohepatitis Clinical Research Network, enrolled 484
children with NAFLD between two-and-17-years-old. The participants’
blood pressure was assessed at enrollment and at 48 weeks. Nearly 36
percent of the group had high blood pressure at baseline; 21 percent had
persistent high blood pressure almost a year later. In comparison, high
blood pressure was present in two to five percent of all children and
10 percent of obese children.
“Along with being at an increased risk for cardiovascular disease, we
found that children with NAFLD who had high blood pressure were
significantly more likely to have more fat in their liver than children
without high blood pressure. This could lead to a more serious form of
liver disease,” said Schwimmer.
Researchers also found that compared to boys, girls with NAFLD were
significantly more likely to have persistent high blood pressure.
Currently, there are no approved and effective treatments for
children with NAFLD. However, there are treatments for high blood
pressure.
“There are some reasons to believe that blood pressure control could
be beneficial for NAFLD. Thus, we may be able to decrease the risk of
premature cardiovascular disease in these children, and also help their
liver,” said Schwimmer. “Parents and doctors need to be aware of the
health risks of children who have NAFLD. The sooner high blood pressure
is identified and treated in this patient population, the healthier they
will be as they transition into adulthood.”
Co-authors include Anne Zepeda and Kimberly P. Newton, UC San Diego;
Cynthia Behling, Sharp Medical Center; Erin K. Hallinan, Michele
Donithan and James Tonascia, Johns Hopkins Bloomberg School of Public
Health; and Stavra A. Xanthakos, Cincinnati Children’s Hospital Medical
Center.
The study was supported in part by the NASH Clinical Research Network
and the National Institute of Diabetes and Digestive and Kidney
Diseases (grants U01DK061718, U01DK061728, U01DK061731, U01DK061732,
U01DK061734, U01DK061737, U01DK061738, U01DK061730, U01DK061713); the
National Center for Advancing Translational Sciences (grants
UL1TR000439, UL1TR000077, UL1TR000436, UL1TR000150, UL1TR000424,
UL1TR000006, UL1TR000448, UL1TR000040, UL RR031980, UL1TR000100,
UL1TR000004, UL1TR000423, UL1TR000058, UL1TR000067, UL1TR000454); and
the National Institute of Child Health and Human Development and the
National Cancer Institute (grant 8TL1TR000098-03).