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Maternal and Perinatal Risk Factors for Pediatric Nonalcoholic Fatty Liver Disease: A Systematic Review
Ilya Querter1, Nele S Pauwels2, Ruth De Bruyne3
1Hepatology Research Unit, Department of Internal Medicine and Pediatrics, Liver Research Center Ghent, Ghent University, Ghent.
Insights
Maternal obesity increases the risk of pediatric nonalcoholic fatty liver disease (NAFLD). Breastfeeding for at least six months may protect children from developing NAFLD, highlighting early life factors in liver health.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Metabolic Health and Disease
- Public Health and Epidemiology
Background:
- Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver condition in children.
- The early life environment significantly influences long-term metabolic health.
- Understanding risk factors for pediatric NAFLD is crucial for public health interventions.
Purpose of the Study:
- To investigate the impact of maternal prepregnancy obesity, gestational diabetes, breastfeeding, and birth anthropometrics on pediatric NAFLD development.
- To identify modifiable risk factors for nonalcoholic fatty liver disease in children and adolescents.
Main Methods:
- A systematic review and meta-analysis of studies published through August 2020.
- Inclusion of data from MEDLINE, PubMed Central, EMBASE, and grey literature.
- Independent review of study selection, data extraction, and quality assessment.
Main Results:
- Maternal prepregnancy overweight and obesity were identified as significant risk factors for pediatric NAFLD.
- Breastfeeding, particularly for durations of six months or longer, was associated with a reduced risk of NAFLD, steatohepatitis, and fibrosis.
- Evidence regarding the impact of (pre)gestational diabetes and birth anthropometrics (preterm birth, small for gestational age) on pediatric NAFLD remains conflicting or unclear.
Conclusions:
- Maternal prepregnancy overweight and obesity are linked to an increased risk of developing nonalcoholic fatty liver disease in children.
- Sufficiently long breastfeeding duration (≥6 months) may offer a protective effect against pediatric NAFLD.
- Early life environmental factors play a critical role in the pathogenesis of pediatric NAFLD.
Background & Aims:
Nonalcoholic fatty liver disease (NAFLD) has become the most common pediatric liver disease. The intrauterine and early life environment can have an important impact on long-term metabolic health. We investigated the impact of maternal prepregnancy obesity, (pre)gestational diabetes, breastfeeding, and birth anthropometrics/preterm birth on the development of NAFLD in children and adolescents.
Methods:
A comprehensive search was performed in MEDLINE, PubMed Central, EMBASE, and grey literature databases through August 2020. The primary outcome was the prevalence of pediatric NAFLD, whereas the histologic severity of steatohepatitis and/or fibrosis were secondary outcomes. Study selection, data extraction, and quality assessment were performed by 2 independent reviewers.
Results:
Our systematic review included 33 articles. Study heterogeneity regarding patient populations, diagnostic tools, and overall quality was considerable. Eight studies determined the impact of maternal prepregnancy overweight/obesity and identified this as a possible modifiable risk factor for pediatric NAFLD. Conversely, 8 studies investigated (pre)gestational diabetes, yet the evidence on its impact is conflicting. Breastfeeding was associated with a reduced risk for NAFLD, steatohepatitis, and fibrosis, especially in studies that evaluated longer periods of breastfeeding. Being born preterm or small for gestational age has an unclear impact on the development of NAFLD, although an early catch-up growth might drive NAFLD.
Conclusions:
In a systematic review, we found that maternal prepregnancy overweight and obesity were associated with an increased risk of pediatric NAFLD. Breastfeeding might be protective against the development of NAFLD when the duration of breastfeeding is sufficiently long (≥6 months).
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