STEATOHEPATITIS IN OBESITY CHILDREN

Abstract

Steatohepatitis is hepatic steatosis with inflammation and, in some cases, hepatocyte balloon degeneration and fibrosis [1]. Steatohepatitis is a form of non-alcoholic fatty liver disease (NAFLD), which includes a wide range of conditions: from non-alcoholic steatosis (NAS) - fat deposition in the liver of more than 5% of the parenchymal mass without signs of damage to hepatocytes to non-alcoholic steatohepatitis (NASH), which progresses with development fibrosis, cirrhosis and, in some patients, hepatocellular carcinoma [1]. The prevalence of steatohepatitis in the pediatric population, according to various sources, varies greatly. Thus, the recommendations of the North American Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists (NASPGHAN) indicate that hypertransaminasemia occurs in 29-38% of obese children aged 2-4 years [1]. According to A. Sahota et al. [2], NASH was found in 12% of obese and overweight children. The joint recommendations for the diagnosis, treatment and prevention of obesity in children and adolescents of the Russian Association of Endocrinologists, the Russian Society for the Prevention of Non-Infectious Diseases, and the Association of Pediatric Cardiologists of Russia note that NASH is diagnosed in 12-26% of obese children and adolescents [3]. Obesity and overweight currently affect 25-30% of school-age children [4]. The situation is almost the same for preschool children. The COSI (Childhood Obesity Surveillance Initiative) study, conducted under the WHO program in Moscow in 2017-2018, summing up the dynamics of body weight for the entire preschool period, showed that among children aged 7 years, 27% of boys were overweight and 22% of girls, and obesity - in 10 and 6%, respectively [5].  Another Russian study assessing the physical development of children of middle and school age [6] also demonstrated a significant prevalence of obesity and overweight in this age group in Russian regions. Thus, at 11 years of age, obesity in boys was recorded in 18.6% of cases, in girls - in 9.2%, and excess body weight - in 15.4 and 14.3%, respectively. At the age of 15, obesity was detected in 10% of cases among boys, in 3.6% of girls, and overweight in 11.5 and 10.5% of cases, respectively [6]. Based on these data, it can be assumed that the incidence of NASH in the pediatric population varies from 0.5 to 3%. It should be noted that the prevalence of obesity, and with it NAFLD, including NASH, is increasing throughout the world due to modern negative trends in the diet and physical activity of children [7].