https://pubmed.ncbi.nlm.nih.gov/33862225/ NAFLD

Clin Gastroenterol Hepatol. 2021 Apr 13;S1542-3565(21)00448-1.
doi: 10.1016/j.cgh.2021.04.014. Online ahead of print.

Maternal and perinatal risk factors for pediatric non-alcoholic fatty liver disease: A systematic review

Ilya Querter 1, Nele S Pauwels 2, Ruth De Bruyne 3, Ellen Dupont 4, Xavier Verhelst 1, Lindsey Devisscher 5, Hans Van Vlierberghe 1, Anja Geerts 1, Sander Lefere 6

Abstract

Background and aims: Non-alcoholic fatty liver disease (NAFLD) has become the most common pediatric liver disease. The intrauterine and early life environment can have an important impact on the long-term metabolic health. We investigated the impact of maternal pre-pregnancy 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, while the histological severity of steatohepatitis and/or fibrosis were secondary outcomes. Study selection, data extraction and quality assessment were performed by two independent reviewers.

Results: Our systematic review included 33 papers. Study heterogeneity regarding patient populations, diagnostic tools and overall quality was considerable. Eight studies determined the impact of maternal pre-pregnancy overweight/obesity and identified this as a possible modifiable risk factor for pediatric NAFLD. Conversely, eight 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 pre-pregnancy 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).