The association between retinal microvascular changes, metabolic risk factors, and liver histology in pediatric patients with non-alcoholic fatty liver disease (NAFLD)

• Published in: Journal of gastroenterology Vol. 50; no. 8; pp. 903 - 912
• Main Authors: Liccardo, D., Mosca, A., Petroni, S., Valente, P., Giordano, U., Mico’, A. G. A., Pescosolido, S., Buzzonetti, L., Nobili, Valerio
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-08-2015; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adolescent; Anthropometry - methods; Arteries - abnormalities; Arteries - pathology; Arteries - physiopathology; Biliary Tract; Biopsy; Blood pressure; Blood Pressure Monitoring, Ambulatory - methods; Body mass index; Child; Children; Colorectal Surgery; Female; Gastroenterology; Health aspects; Hepatology; Humans; Hypertensive Retinopathy - etiology; Hypertensive Retinopathy - pathology; Hypertensive Retinopathy - physiopathology; Joint Instability - etiology; Joint Instability - pathology; Joint Instability - physiopathology; Liver - pathology; Liver diseases; Male; Measurement; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Non-alcoholic Fatty Liver Disease - complications; Non-alcoholic Fatty Liver Disease - pathology; Non-alcoholic Fatty Liver Disease - physiopathology; Obesity in children; Original Article—Liver; Pancreas; Pediatrics; Retinal Vessels - pathology; Retrospective Studies; Risk Factors; Severity of Illness Index; Skin Diseases, Genetic - etiology; Skin Diseases, Genetic - pathology; Skin Diseases, Genetic - physiopathology; Surgical Oncology; Type 2 diabetes; Vascular Malformations - etiology; Vascular Malformations - pathology; Vascular Malformations - physiopathology; Vision disorders in children; Obesity; Hypertensive retinopathy; Non-alcoholic fatty liver disease; Metabolic syndrome; Microvascular complications
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-014-1024-1

Background
The prevalence of childhood obesity is increasing worldwide. Studies in adult populations show that retinal microvascular changes are associated with obesity and components of the metabolic syndrome. In our study we have assessed the effect of body mass index (BMI), metabolic parameters, and adiposity on the retinal microvasculature in children.
Methods
Fifty-four consecutive children with biopsy-proven NAFLD were enrolled in this study. Anthropometric and laboratory parameters were obtained using standardized protocols. Retinal caliber was quantified from digital retinal images using well-known computer-based programs. Twenty-four-hour ambulatory blood pressure monitoring was measured using a standard protocol.
Results
In our population, the prevalence of retinopathy was of 53 % (13 males). The 29 patients with retinopathy (mean age 10.91 ± 3.10) showed significantly higher values of triglycerides (mg/day) (105.57 vs. 90.20,
p
 = 0.04), basal insulin (mUI/ml) (17.20 vs. 12.97,
p
 = 0.02), and HOMA-IR (3.37 vs. 2.76,
p
 = 0.04). The patients with a HOMA-IR >2.5 (OR = 3.34,
p
 = 0.02; 95 % IC, 1.07–10.39), and systolic non-dipping (OR 4.16,
p
 = 0.028, 95 % IC, 1.11–13.67), have an increased risk of retinopathy. Moreover, the study of correlation between all stages of liver biopsy (CRN criteria) and the grade of retinopathy showed a positive correlation with fibrosis (
r
 = 0.31) and an NAS score (
r
 = 0.28).
Conclusions
We found an association between metabolic parameters and nocturnal blood pressure on the retinal microvasculature among the obese children with NAFLD. Furthermore, for the first time, we report the positive relationship between hepatic fibrosis in pediatric NAFLD patients and the degree of retinopathy signs.