From the liver to the heart: Cardiac dysfunction in obese children with non-alcoholic fatty liver disease

Table 1 Principal features and findings of the studies regarding the association between non-alcoholic fatty liver diseas and cardiac dysfunction

Ref.	Study design and methods	Population (n)	Main findings
Bonci et al[4]	Systematic review and meta-analysis Systematic literature search for papers from January 2000 to September 2014	12 observational studies: 9 studies based on adult population and 3 studies performed in pediatric population were selected	Children with NAFLD were not different from those without for LV mass Both children with and without NAFLD presented an increased LV mass compared to controls However children with NAFLD presented higher E/e’ ratio rather those without NAFLD
D’Adamo et al[7]	Cross-sectional study NAFLD diagnosis performed by MRI Evaluation of VAT Lipoprotein particle characterized by MRS	Mean age 14.6 yr Obese African American (33) Obese Hispanic (33)	In multiple regression analyses liver fat accumulation resulted independently and significantly related to large VLDL concentrations
Sert et al[14]	Cross-sectional study NAFLD diagnosis performed by ultrasound and elevated serum alanine aminotransferase Pulsed and tissue doppler Echocardiography	Mean age 13.3 yr Healthy (68) Obese with NAFLD and elevated ALT (97)	NAFLD children showed increased CIMT and abnormalities of both LV structure and function LV CIMT and LV mass were positively related to HOMA-IR in obese children with NAFLD
Alp et al[15]	Cross-sectional study NAFLD diagnosis performed by liver biopsy Echocardiography Tissue doppler Echocardiography	Obese without NAFLD and low ALT (83) Mean age 12 yr Healthy (150) Obese with NAFLD at United States (93) Obese without NAFLD at United States (307)	NAFLD group had increased epicardial fat thickness, end-systolic thickness of the interventricular septum, and larger LV mass, as well as LV systolic and diastolic dysfunction
Pacifico et al[18]	Cross-sectional study NAFLD diagnosis performed by MRI	Mean age 12.5 yr Healthy (18)	Children with NAFLD presented signs of left ventricular dysfunction compared to children without NAFLD Subjects with a more severe NASH had a worse cardiac dysfunction
Singh et al[19]	Liver biopsy for NASH in 41 subjects Echocardiography Cross-sectional study NAFLD diagnosis performed by MRS Echocardiography	Obese with NAFLD at MRI (54) Obese without NAFLD at MRI (54) Mean age 15 yr Lean (14) Obese with Intrahepatic triglyceride content (15) Obese with increased Intrahepatic triglyceride content (15)	Obese adolescents with NAFLD show a worse systolic and diastolic functions rather than lean and obese adolescents without NAFLD independent from anthropometric parameters and blood pressure

MRI: Magnetic resonance imaging; NAFLD: Nonalcoholic fatty liver disease; MRS: Magnetic resonance spectrometry; VAT: Visceral adipose tissue; NASH: Non-alcoholic steatohepatitis; LV: Left ventricular; ALT: Alanine transaminase; CIMT: Carotis intima media thickness; VLDL: Very low density lipoproteins.