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(Circulation. 2008;118:277-283.)
© 2008 American Heart Association, Inc.

Pediatric Cardiology

Cardiovascular Risk Factors and the Metabolic Syndrome in Pediatric Nonalcoholic Fatty Liver Disease

Jeffrey B. Schwimmer, MD; Perrie E. Pardee, BS; Joel E. Lavine, MD, PhD; Aaron K. Blumkin, MS; Stephen Cook, MD

From the Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego (J.B.S., P.E.P., J.E.L.); Department of Gastroenterology, Rady Children’s Hospital San Diego, San Diego, Calif (J.B.S., J.E.L.); and Department of Pediatrics, University of Rochester Medical Center, Rochester, NY (A.K.B., S.C.).

Correspondence to Jeffrey B. Schwimmer, MD, Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, 200 W Arbor Dr, San Diego, CA 92103–8450. E-mail jschwimmer{at}ucsd.edu

Received September 14, 2007; accepted May 8, 2008.

Background— Nonalcoholic fatty liver disease (NAFLD), the most common cause of liver disease in children, is associated with obesity and insulin resistance. However, the relationship between NAFLD and cardiovascular risk factors in children is not fully understood. The objective of this study was to determine the association between NAFLD and the presence of metabolic syndrome in overweight and obese children.

Methods and Results— This case-control study of 150 overweight children with biopsy-proven NAFLD and 150 overweight children without NAFLD compared rates of metabolic syndrome using Adult Treatment Panel III criteria. Cases and controls were well matched in age, sex, and severity of obesity. Children with NAFLD had significantly higher fasting glucose, insulin, total cholesterol, low-density lipoprotein cholesterol, triglycerides, systolic blood pressure, and diastolic blood pressure than overweight and obese children without NAFLD. Subjects with NAFLD also had significantly lower high-density lipoprotein cholesterol than controls. After adjustment for age, sex, race, ethnicity, body mass index, and hyperinsulinemia, children with metabolic syndrome had 5.0 (95% confidence interval, 2.6 to 9.7) times the odds of having NAFLD as overweight and obese children without metabolic syndrome.

Conclusions— NAFLD in overweight and obese children is strongly associated with multiple cardiovascular risk factors. The identification of NAFLD in a child should prompt global counseling to address nutrition, physical activity, and avoidance of smoking to prevent the development of cardiovascular disease and type 2 diabetes.

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CLINICAL PERSPECTIVE

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Clinical Summaries
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