2013 - ISBTS 2013 Symposium

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Oral Communications 6 / Clinical Cases 2

27.341 - Increased serum fibroblast growth factor 21 (FGf21) levels associate with liver steatosis and duration of parenteral nutrition in pediatric intestinal failure

Presenter: Annika, Mutanen, , Finland
Authors: Annika Mutanen¹, Taneli Raivio², Hannu Jalanko³, Antti Koivusalo¹, Risto Rintala¹, Mikko Pakarinen¹

INCREASED SERUM FIBROBLAST GROWTH FACTOR 21 (FGF21) LEVELS ASSOCIATE WITH LIVER STEATOSIS AND DURATION OF PARENTERAL NUTRITION IN PEDIATRIC INTESTINAL FAILURE

Annika Mutanen¹, Taneli Raivio², Hannu Jalanko³, Antti Koivusalo¹, Risto Rintala¹, Mikko Pakarinen¹

¹Pediatric surgery, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland; ²institute of Biomedicine/Physiology, Biomedicum Helsinki, Helsinki, Finland; ³Pediatric Nephrology and Transplantation Surgery, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland

Aim of the study. FGF21 regulates hepatic glucose production and lipid metabolism, and associates with fatty liver disease. We investigated association of serum FGF21 levels with histology and function of the liver, glucose homeostasis, and serum lipids in pediatric intestinal failure (IF).

Methods. After an ethical approval serum FGF21, liver enzymes, lipids and HbA1c were measured in 35 IF patients at median age of 7.8 years (range 1.1-27) and in 59 healthy age-matched controls. Thirty patients underwent liver biopsy. Ten patients remained on parenteral nutrition (PN) after mean 75 (range 2.8-170) months, and 25 had weaned off PN 8.9 (0.3-27) years before after 32 (0.7-250) PN months.

Main Results. Serum FGF21 levels were significantly increased in patients compared to controls [median 229 (IQR 76-627) vs 133 (68-294), P=0.036], the values being comparable (P=0.083) before and after weaning off PN. Histological steatosis was equally common before and after weaning off PN (60% vs 50%, P=0.611). The patients with liver steatosis had higher serum FGF21 levels [median 626 pg/mL (IQR 228-1780)] compared to patients (n=14) without [median 107 (IQR 59-294), P=0.002] steatosis. Serum FGF21 correlated positively with the degree of hepatic steatosis (r=0.589, P=0.001). The duration of PN was positively associated with serum FGF21 level (r=0.580, P=0.001) and histological fat accumulation of the liver (r=0.589, P=0.001).

Serum FGF21 levels were unrelated to GT, AST, HbA1c, total cholesterol, HDL cholesterol, LDL cholesterol or triglyseride levels or liver Metavir fibrosis score or cholestasis grade (r=-0.301-0.240, P=0.078-0.749).

Conclusion. Serum FGF21 levels are increased and associate with liver steatosis and duration of PN in pediatric IF patients. FGF21 may have important implications in the pathogenesis and diagnostics of IF associated liver disease.

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