Nonalcoholic fatty liver disease and the heart in children and adolescents

Table 2 Studies of the association between nonalcoholic fatty liver disease and alterations in cardiac structure and function in the adult population

Ref.	Study population and sample size	Diagnosis	Outcomes	Main results
Lautamäki et al[15]	T2DM and coronary artery disease patients with (n = 27), and without (n = 28) fatty liver. The 2 groups were matched for age, BMI, and fasting plasma glucose	Hepatic MRS	Myocardial insulin resistance and perfusion (PET)	In patients with T2DM and coronary artery disease, liver fat is an indicator of myocardial insulin resistance and reduced coronary functional capacity
Goland et al[17]	Nondiabetic, normotensive patients with NAFLD (n = 38), and age and gender-matched controls (n = 25)	Liver ultrasound and liver biopsy in a subgroup of 11 NAFLD patients	LV structure and function (M-mode echocardiography; and pulsed Doppler echocardiography)	Patients with NAFLD had mild changes in cardiac geometry (thickening of the interventricular septum and posterior wall, and increased LV mass) as well as significant differences in parameters of diastolic function compared with the control group
Perseghin et al[16]	Young nondiabetic men matched for anthropometric features with (n = 21) or without (n = 21) fatty liver	MRS	LV morphology and function; Intrapericardial and extrapericardial fat content; and resting LV energy metabolism (Cardiac MRI and cardiac 31P-MRS)	Newly found young individuals with fatty liver had excessive fat accumulation in the epicardial area and abnormal LV energy metabolism despite normal LV morphological features and systolic and diastolic functions
Fallo et al[45]	Never-treated essential hypertensive patients with (n = 48) or without (n = 38) fatty liver. The 2 groups were similar as to gender, age and blood pressure levels	Liver ultrasound	LV structure and function (M-mode echocardiography; and pulsed Doppler echocardiography)	NAFLD patients had similar prevalence of LV hypertrophy compared to subjects without NAFLD, but a higher prevalence of LV diastolic dysfunction
Rijzewijk et al[46]	T2DM patients with (n = 32) and without (n = 29) fatty liver	MRS	Cardiac perfusion and substrate metabolism; LV morphology and function (PET, cardiac MRI and cardiac 31P-MRS)	T2DM patients with fatty liver showed decreased myocardial perfusion, glucose uptake, high-energy phosphate metabolism compared with similar patients without hepatic steatosis
Fotbolcu et al[18]	Nondiabetic, normotensive patients with NAFLD (n = 35) and control subjects (n = 30). The 2 groups were similar as to gender and age	Liver ultrasound	LV structure and function (M-mode echocardiography; Pulsed and Tissue Doppler echocardiography)	Patients with NAFLD had changes in cardiac geometry (thickening of the interventricular septum and posterior wall, and increased LV mass) as well as significant differences in parameters of systolic and diastolic function compared with the control group
Bonapace et al[47]	T2DM patients with (n = 32) and without (n = 18) fatty liver. The 2 groups were similar as to gender, age, BMI, waist circumference, and diabetes duration	Liver ultrasound	LV structure and function (M-mode echocardiography; Pulsed and Tissue Doppler echocardiography)	T2DM patients with fatty liver showed LV diastolic dysfunction, even if the LV morphology and systolic function were preserved
Mantovani et al[48]	Hypertensive T2DM patients with (n = 59) and without (n = 57) fatty liver	Liver ultrasound	LV structure (M-mode echocardiography)	Hypertensive T2DM patients with NAFLD have a remarkably higher frequency of LV hypertrophy than hypertensive diabetic patients without NAFLD
Hallsworth et al[49]	Adult subjects matched for anthropometric features with (n = 19) or without (n = 19) fatty liver	MRS	Cardiac structure, function, and metabolism (cardiac MRI, cardiac tagging, and cardiac 31P-MRS)	The major findings in NAFLD patients compared to controls were: thickening of the cardiac wall, independent of changes in LV mass; altered myocardial strains; concentric remodeling; evidence of diastolic dysfunction; but no significant difference in cardiac energetics
Karabay et al[50]	NAFLD patients (n = 55) and healthy controls (n = 21; normal laboratory values and liver ultrasound)	Liver biopsy	LV structure and function (M-mode echocardiography; Pulsed and Tissue Doppler echocardiography; and speckle tracking echocardiography)	Patients with NAFLD had changes in cardiac geometry (thickening of the interventricular septum and posterior wall, and increased LV mass) as well as significant differences in parameters of diastolic function compared with the control group
				LV global longitudinal strain and strain rate in systole were lower in NAFLD group as compared to controls; however no significant differences were found among NAFLD groups (i.e., simple steatosis, borderline NASH, and definite NASH)

T2DM: Type 2 diabetes mellitus; BMI: Body mass index; MRS: Magnetic resonance spectroscopy; PET: Positron emission tomography; NAFLD: Nonalcoholic fatty liver disease; LV: Left ventricular; NASH: Nonalcoholic steatohepatitis.