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Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the United States and the most common disease seen in the Pediatric Liver Center at Children’s Hospital Colorado’s Digestive Health Institute.
Previously considered an adult disease, NAFLD now widely impacts children— and its occurrence has been increasing in younger ages. While the rise in NAFLD has seemingly gone hand-in-hand with the growing pediatric obesity epidemic, not all children who are obese suffer from NAFLD and not all children with NAFLD are obese.
Patients with NAFLD are at risk for obstructive sleep apnea (OSA) and chronic intermittent nocturnal hypoxia. Poor breathing leads to poor oxygenation, and hypoxia and ischemia can increase liver damage. This concept led principal investigator Shikha Sundaram, MD, and other researchers in our Digestive Health Institute to wonder, “What does OSA do to patients with non-alcoholic fatty liver disease?”
Between June 2009 and January 2014, researchers in the Digestive Health Institute studied pediatric patients ages 8 to 18 years old with confirmed NAFLD after liver biopsy. Lean age-matched control subjects with no liver disease were also enrolled. NAFLD subjects had significantly elevated aminotransferases, inflammatory markers and evidence of the metabolic syndrome compared to the lean controls.
Researchers then studied the following:
Key findings included:
Study data show sleep-disordered breathing is an important trigger of oxidative stress that promotes the progression of pediatric NAFLD to NASH. Further studies are being conducted to demonstrate if effective treatment of OSA and nocturnal hypoxia in obese patients will prevent or reverse NASH.
The Pediatric Liver Center team welcomes consultations and can be reached at 720-777-6669. The center offers specialized staff for weight loss training and counseling, understanding of and evaluation of co-morbidities and novel treatments and clinical trials.