Liver Fibrosis Index Reduces the Need for Biopsies in Children

A new noninvasive diagnostic index has been developed that may be used in tertiary care to help diagnose liver fibrosis in children with nonalcoholic fatty liver disease (NAFLD).

Researchers from the pediatric hospital Bambino Gesù (Rome, Italy) assessed the factors that were associated with fibrosis in 203 children treated at the hospital's liver unit. The study included 136 male and 67 female children with NAFLD aged 3.3-18.0 years; 141 (69%) of them had fibrosis at liver biopsy. The researchers then evaluated the following potential predictors of liver fibrosis: gender, age, body mass index (BMI), waist circumference, alanine transaminase, aspartate transaminase, gamma-glutamyl-transferase, albumin, prothrombin time, glucose, insulin, triglycerides, and cholesterol. The analysis revealed that by inputting a child's age, waist circumference, and triglyceride levels into a relatively simple equation, it was possible to gain a useful indication of the likelihood of fibrosis, and a final model was developed using logistic regression with bias-correction, which was named the pediatric NAFLD fibrosis index (PNFI), which values that vary between 0 and 10. The researchers concluded that a PNFI equal or higher than 9 could be used to rule in liver fibrosis without performing a liver biopsy. The study describing the new index was published on May 1, 2009, in the open access journal BMC Medicine, a publication of BioMed Central.

"Diagnosis of liver fibrosis is currently based on liver biopsy. However, this is invasive and limited by the hazard and discomfort to the patient," said lead author Valerio Nobili, M.D., of the department of hepatogastroenterology and nutrition. "Thus, there is a recognized need for less invasive strategies to identify the minority of NAFLD patients with liver fibrosis."

NAFLD is fatty inflammation of the liver when this is not due to excessive alcohol use. It is related to insulin resistance and the metabolic syndrome, and is a highly prevalent and potentially very serious complication of childhood obesity. The early identification of fibrosis is particularly important in children as it may help prevent the development of liver disease in adulthood.

Pediatric Hospital Bambino Gesù


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