Ultrasonographic assessmentoftheextentofhepatic steatosis inseveremalnutrition

Ultrasonographic, blinded assessment was madeoftheextentofhepatic steatosis in55 children with severemalnutrition: undernutrition(n=6), marasmus (n=18),marasmickwashiorkor (n=17), andkwashiorkor (n=14). Thechildren were examined on admission, in early recovery(considered as baseline), and againatdischarge. Elevenhealthy control children andeightofthepreviously malnourished children werestudied ascomparison groups. Bothoedematous and non-oedematous malnourished children hadsignificantly more steatosis thanthecomparison groupsateach time. Children withoedematous malnutrition hadsignificantly greatersteatosis thannonoedematous children atadmission. Halfofthe non-oedematous malnourished children had appreciable hepatic steatosis atbothadmission andatbaseline. Hepatic fat was onlyslowly mobilised. The rateconstant was 1.4+0.3%/day. Onequarter ofthechildren didnotchange steatosis grades during theperiod they were inhospital. There was no overall correlation between theextent ofsteatosis andliver size. Hepatic steatosis inchildhood malnutrition isnotconfined tooedematous children: itis frequently presentinmarasmic andundernourished children. Its extent isnotnecessarily related tothedegreeofhepatomegaly and accumulated lipid isonlyslowly mobilised.