SAN FRANCISCO – Factors that can be measured in the first few years of life can predict whether a child will develop nonalcoholic fatty liver disease (NAFLD) by adolescence, suggests a study presented at the annual meeting of the American Association for the Study of Liver Diseases.

Investigators in Australia led by Dr. Oyekoya T. Ayonrinde prospectively followed more than 1,000 children from birth to adolescence, by which time one in eight had developed NAFLD, now the most common chronic liver disorder in pediatric and adult populations in many countries. The data showed distinctly different trajectories for measures of adiposity and systolic blood pressure between the children who did and did not develop NAFLD.

Additionally, greater values for measures of adiposity at various ages in the first decade of life were among the independent positive predictors of NAFLD, whereas longer duration of breastfeeding and, among girls, larger head circumference were among the independent negative predictors.

"There seems to be a potential protective role of breastfeeding on NAFLD, which needs to be explored further," Dr. Ayonrinde commented. "There [are] some data to show that breastfeeding is associated with lower insulin release and also less-rapid weight gain. And it has also been associated with larger head circumference as well, so that probably ties in to some degree."

The study’s findings have implications for pediatric health assessments, he maintained. "Routine recording of childhood anthropometrics is recommended. The trajectory of systolic blood pressure and any adiposity measure during childhood identifies those at particular risk of NAFLD and associated metabolic disorders, who may benefit from further targeted assessment."

Explaining the study’s rationale, Dr. Ayonrinde noted that little is known about the natural history of NAFLD, and the disease is underdiagnosed. "So it makes sense to consider that the identification of children at risk of NAFLD through longitudinal studies may provide improved understanding of the natural history and potential opportunities for prevention and therapy of NAFLD," he said.

The investigators followed 1,170 children who were participating in the Raine Study, a birth cohort study conducted in western Australia. The children had serial anthropometric measurements between birth and the age of 17 years.

Liver ultrasound was performed when the participants were aged 17 years. Boys consuming at least two alcoholic drinks per day and girls consuming at least one alcoholic drink per day were excluded from the study to reduce that possible source of confounding, he noted.

Study results showed that by the age of 17 years, fully 13% of the children – 16% of girls and 10% of boys – had developed NAFLD, according to Dr. Ayonrinde, a gastroenterologist at the University of Western Australia in Perth.

A case-control analysis of the children who did and did not develop NAFLD showed that none of the anthropometric factors assessed at birth were associated with NAFLD, nor was weight gain in the first year of life. But breastfeeding was highly protective: Infants breastfed for more than 6 months were less than half as likely to have NAFLD as adolescents.

The earliest anthropometric measure to show an association with NAFLD was smaller head circumference (at the age of 1 year in girls), and the strongest predictor overall was suprailiac skinfold thickness, Dr. Ayonrinde reported.

In addition, the children who did and did not develop NAFLD had significantly different trajectories throughout childhood when it came to head circumference (in girls only), body weight, body mass index, various skinfold thicknesses, and systolic blood pressure.

In a multivariate analysis, boys were more likely to develop NAFLD if they had a greater suprailiac skinfold thickness at age 3 years, a greater chest circumference at age 5 years, a greater body mass index at age 8 years, or a greater suprailiac skinfold thickness at age 10 years (odds ratios ranged from 1.11 to 1.37). Boys were less likely to develop NAFLD if they were breastfed for longer as infants (OR, 0.91).

Girls were more likely to develop NAFLD if they had a higher body weight at age 3 years, a greater suprailiac skinfold thickness or chest circumference at age 5 years, a greater chest circumference at age 8 years, or a larger suprailiac skinfold thickness at age 10 years (OR, 1.08-1.44). Girls were less likely to develop NAFLD if they were breastfed for longer as infants or if they had a larger head circumference at age 3, 5, or 8 years (OR, 0.62-0.90).

Data on maternal factors, such as obesity and diabetes, and on socioeconomic factors, are available in the dataset but have not yet been analyzed, according to Dr. Ayonrinde.

Dr. Ayonrinde reported that he had no relevant conflicts of interest.

NAFLD in Adolescence Predictable in Young Children