Liver steatosis in Polish children assessed by medico-legal autopsies

Marta Rorat, Tomasz Jurek, Ernest Kuchar, Leszek Szenborn, Wojciech Golema, Agnieszka Halon

Wroclaw, Poland

Author Affiliations: Department of Forensic Medicine (Rorat M, Jurek T, Golema W), Department of Pediatrics and Infectious Diseases (Kuchar E, Szenborn L), Department of Pathological Anatomy (Halon A), Wroclaw Medical University, Poland

Corresponding Author: Marta Rorat, Department of Forensic Medicine, Medical University of Wroclaw, Mikulicza Radeckiego 4, Wroclaw 50-368, Poland (Tel: +48-71-784-14-74; Fax: + 48-71-784-00-95; Email: marta.rorat@gmail.com)

doi: 10.1007/s12519-012-0387-8

Background: Cases of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are increasing in the pediatric population. Their growing prevalence coincides with the obesity epidemic. Assessment of the incidence requires liver biopsies on a representative population sample, which are hampered by the absence of indications for invasive examination on children without clinical symptoms. The aim of the current study was to assess the incidence of liver steatosis in the population of children up to 18 years old from Lower Silesia.

Methods: We retrospectively reviewed 342 medico-legal autopsy reports from 2000 to 2009. We separated a group of 256 children whose death was caused by trauma. Liver steatosis was diagnosed according to the results of histopathological examinations and typical macroscopic imaging.

Results: In the 265 children who died from trauma, liver steatosis was reported in 11 (4.2%) children (6 boys) aged between 6 months and 18 years old. Six of the 11 children (54.5%) were found to be overweight. In all 342 children, steatosis was found in 18 (5.3%) children (13 boys), while NASH was diagnosed in 1 (0.3%). Excess body weight was observed in 55.6% (10/18) of children with steatosis.

Conclusions: Liver steatosis can occur at any age, even in infancy. Being overweight is a very important risk factor. Gross examination of the liver is insufficient for the diagnosis of steatosis because of its lower sensitivity and specificity. Verification of liver steatosis requires reference histopathological examination.

Key words: autopsy; liver steotosis; non-alcoholic fatty liver disease; obesity

World J Pediatr 2013;9(1):68-72