https://pubmed.ncbi.nlm.nih.gov/33545191/ NAFLD
J Pediatr. 2021 Feb 2;S0022-3476(21)00098-6.
doi: 10.1016/j.jpeds.2021.01.064. Online ahead of print.

Hepatic steatosis is negatively associated with bone mineral density in children

Lauren F Chun 1, Elizabeth L Yu 2, Mary Catherine Sawh 2, Craig Bross 1, Jeanne Nichols 3, Lynda Polgreen 4, Cynthia Knott 5, Alexandra Schlein 6, Claude B Sirlin 6, Michael S Middleton 6, Deborah M Kado 7, Jeffrey B Schwimmer 8

Abstract

Objective: To evaluate the relationship between hepatic steatosis and bone mineral density (BMD) in children. Additionally, to assess 25-hydroxyvitamin D levels in the relationship between hepatic steatosis and BMD.

Study design: A community-based sample of 235 children was assessed for hepatic steatosis, BMD, and serum 25-hydroxyvitamin D. Hepatic steatosis was measured by liver magnetic resonance imaging proton density fat fraction (MRI-PDFF). BMD was measured by whole-body dual-energy X-ray absorptiometry (DXA).

Results: The mean age of the study population was 12.5 years (SD 2.5 years). Liver MRI-PDFF ranged from 1.1% to 40.1% with a mean of 9.3% (SD 8.5%). Across this broad spectrum of hepatic fat content, there was a significant negative relationship between liver MRI-PDFF and BMD Z-score (R=-0.421, p<0.001). Across the states of sufficiency, insufficiency and deficiency, there was a significant negative association between 25-hydroxyvitamin D and liver MRI-PDFF (p<0.05); however, there was no significant association between vitamin D status and BMD Z-score (p=0.94). Finally, children with clinically low BMD Z-scores were found to have higher ALT (p<0.05) and GGT (p<0.05) levels compared with children with normal BMD Z-scores.

Conclusions: Across the full range of liver MRI-PDFF, there was a strong negative relationship between hepatic steatosis and BMD Z-score. Given the prevalence of NAFLD and the critical importance of childhood bone mineralization in protecting against osteoporosis, clinicians should prioritize supporting bone development in children with NAFLD.