Mercedes Martinez, MD

Mercedes
Martinez, MD

Adequate nutrition is important for growth and meeting developmental milestones for all children. But for pediatric liver patients, overnutrition or undernutrition can have devastating effects.

Three experts will discuss the effects of nutrition on various pediatric liver diseases during an AASLD Clinical Symposium Tuesday afternoon. The 90-minute symposium, Nutrition and Pediatric Liver Disease, will be co-moderated by Mercedes Martinez, MD, associate professor of pediatrics at New York-Presbyterian Hospital, NY, and Samar H. Ibrahim, MB, ChB, assistant professor of pediatrics at the Mayo Clinic, Rochester, MN.

“Nutrition is the center of care for any pediatric disease, and this symposium is organized to make nutrition the center of attention when it comes to the ramifications of nutrition on liver disease,” Dr. Ibrahim said.

Samar H. Ibrahim, MB, ChB

Samar H. Ibrahim,
MB, ChB

The program will begin with a look at the basic science behind parenteral nutrition associated liver disease, presented by Karim C. El Kasmi, MD, PhD, associate professor of pediatric gastroenterology, hepatology and nutrition at the University of Colorado School of Medicine, Aurora.

“For years, we knew that there was a problem with parenteral nutrition,” Dr. Martinez said. “In the past 10 years, we have recognized that the omega-6 fatty acids are the ones that cause problems. But now we have the immunology behind that, and we will be able to understand how these problems are caused by Kupffer cell activation induced by TLR [toll-like receptor] signaling and that, most of the time, it is induced by interleukin-6 inflammation and cholestasis.”

In the next presentation, Ronald J. Sokol, MD, FAASLD, professor of pediatric gastroenterology, hepatology and nutrition at the University of Colorado School of Medicine, Aurora, will address the nutritional needs and requirements of patients with cholestatic liver disease, and how good nutrition can improve patient outcomes.

“Some of these patients with cholestasis end up requiring liver transplants. Good nutrition is important for a good outcome post-transplant,” Dr. Ibrahim said.

The symposium will conclude with a lecture by Miriam B. Vos, MD, MSPH, assistant professor of pediatrics at the Emory University School of Medicine, Atlanta, GA, who will examine the opposite side of the nutrition spectrum — patients who are overnourished, resulting in nonalcoholic fatty liver disease (NAFLD).

Dr. Vos will discuss how to counsel a patient’s family to modify a child’s diet and increase exercise to avoid progression from NAFLD to more severe forms of disease, such as nonalcoholic steatohepatitis (NASH). She will also address the importance of liver biopsy to confirm the diagnosis of NAFLD.

“If early intervention can be established in the form of diet and exercise, it can improve outcomes because diet and exercise do halt disease progression — from simple fatty infiltration to a more severe phenotype with inflammation and fibrosis. But the importance is adherence,” Dr. Ibrahim said.

Dr. Martinez noted that diagnosing fatty liver disease is a process of exclusion. If liver enzymes remain elevated after several months of weight loss, for example, it’s important to go beyond enzyme testing and ultrasound.

“If you really want to make a diagnosis, the gold standard is the liver biopsy, which will allow you to confirm the diagnosis and tell families how advanced and how dangerous the fat in the liver is,” she said.

Please refer to the DDW Mobile App or the Program section in Tuesday’s DDW Daily News for additional details on this and other DDW® events.