Elevated Hemoglobin Level is Associated With Advanced Fibrosis in Pediatric Non Alcoholic Fatty Liver Disease.

OBJECTIVES: Hemoglobin (Hb) and red blood cell distribution width (RDW) have been reported to be a risk marker of metabolic syndrome (MS) and nonalcoholic fatty liver disease (NAFLD). No study exists on pediatric populations. We aimed to determine the association between hematological parameters, and the severity of disease in children with biopsy proven NAFLD.

METHODS: 117 children (85 males, mean age 12 years) with ultrasound (US) evidence of NAFLD undergoing liver biopsy for diagnosis of non alcoholic steatohepatitis (NASH), were prospectively enrolled between January 2011 and May 2013 in the setting of a tertiary care centre. Children were screened for routine hematological and metabolic parameters, and causes of liver steatosis other than non-alcoholic were excluded, before liver biopsy was performed.

RESULTS: 41 NAFLD (males 29, mean age 11,2 years) and 76 NASH (males 56, mean age 12,8) children were studied. ALT levels were significantly higher in NASH group vs NAFLD group (p = 0,05), as well as HOMA-IR and triglycerides levels (p = 0,03 and 0,02 respectively). Regarding hematological components: red cell count, hemoglobin, hematocrit and RDW values were all significantly higher in NASH group vs NAFLD group (p < 0,05 for each parameter).

CONCLUSION: Children with NASH were more likely to have high levels of RDW compared to those with steatosis only. Moreover, NASH was associated with higher red cell count, hemoglobin and hematocrit. If confirmed in future follow-up studies, hematological parameters might be introduced in algorithms for NASH risk prediction.