On the origin of pediatric nonalcoholic Fatty liver disease.

A t the time of diagnosis, the typical patient seen by a pediatric gastroenterologist for nonalcoholic fatty liver disease (NAFLD) is 12 years old. One of the most common questions that parents ask is: ‘‘when did this begin?’’ Rarely is there a clear answer; however, there is increasing evidence that NAFLD could begin at birth or even in utero. In this issue of the Journal of Pediatric Gastroenterology and Nutrition, Patel et al presents a retrospective autopsy study evaluating the presence and degree of fetal hepatic steatosis and its association with maternal diabetes (1). The authors compared 33 stillborn babies delivered by women with diabetes mellitus (patients) with 48 stillborn babies of women matched for age without diabetes mellitus (controls). For the patients, maternal diabetes was a mixture of gestational diabetes and established type 1 and type 2 diabetes mellitus. The majority of these women were obese (61%) compared with the control group (33%). The main finding of their study was a substantially higher rate of steatosis among patients (79%) versus controls (17%). In addition, the severity of steatosis was greater in the patients and was positively correlated with fetal body weight independent of maternal obesity. Two studies have evaluated hepatic steatosis in neonates through the use of magnetic resonance spectroscopy. Modi et al reported that maternal body mass index at conception was independently correlated with neonatal hepatic fat content (2). Brumbaugh et al reported on hepatic steatosis in 25 neonates born to women with obesity and gestational diabetes or born to women who were normal weight and did not have diabetes mellitus. Liver fat content was 68% higher in those neonates born to women with obesity and gestational diabetes (3). Surprisingly, neonatal adi-