Transcutaneus Electrical Nerve Stimulation Increases Rectal Activity In Children

OBJECTIVE: Since the prevalence of obesity in children is increasing, the frequency of pediatric non-alcoholic fatty liver disease (NAFLD) is growing. A reliable non-invasive biomarker for monitoring progression of liver fibrosis would be useful. In cirrhotic persons serum bile acid (BA) levels are significantly elevated. We hypothesized that BA levels and composition in pediatric NAFLD vary depending on the stage of fibrosis.

METHODS: Children with NAFLD were compared with controls and classified by stages of fibrosis (NAFLD-F0, n = 27; NAFLD-F≥1, n = 65) based on liver-biopsy findings. Fasted metabolic and cholestasis status was assessed by several blood tests. BA profiles were measured by tandem mass spectrometry and compared with healthy controls (n = 105).

RESULTS: Compared with controls, all NAFLD patients were overweight and showed significantly elevated glucose, insulin, AST, and ALT levels. Total serum BA were lower in non-fibrotic NAFLD children than in a control cohort (1.73 vs 3.6 μmol/l) due to low glycine-conjugated BA levels incompletely compensated by increases in taurine-conjugated or unconjugated BA. In fibrotic NAFLD patients BA levels were lower than in controls (2.45 vs 3.6 μmol/l) but higher than in non-fibrotic patients (2.45 vs 1.73 μmol/l) and the BA pattern resembled that of healthy controls. Fibroblast growth factor 19 levels were significantly lower in both NAFLD groups than in controls (p≤0.001) and were positively correlated with ursodeoxycholic acid levels.

CONCLUSION: Our data indicate that serum BA levels decrease in early NAFLD and increase during progression to fibrosis. Given that BA are increased in cirrhotic adults, we postulate a continuous rise as NAFLD advances. BA may have a value as a non-invasive biomarker in pediatric NAFLD progression.