{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T20:52:23Z","timestamp":1789591943693,"version":"build-2803163510"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2016,1,14]],"date-time":"2016-01-14T00:00:00Z","timestamp":1452729600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2016,1,14]],"date-time":"2016-01-14T00:00:00Z","timestamp":1452729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:p>Pediatric nonalcoholic fatty liver disease (NAFLD) histology demonstrates variable amounts of portal inflammation, which may be associated with more severe liver disease and fibrosis. We assessed the relationship between portal inflammation, hepatic fibrosis, and the metabolic syndrome in pediatric NAFLD. Children with biopsy\u2010proven NAFLD were eligible for inclusion. Histology was assessed using Kleiner fibrosis stage and the Nonalcoholic Steatohepatitis Clinical Research Network system for portal inflammation. Patients were divided by histology into type 1, type 2, and overlap NAFLD. Multivariable ordinal logistic regression was used to determine factors associated with fibrosis and portal inflammation. The 430 Caucasian children were divided into 52 with type 1, 95 with type 2, and 283 with overlap NAFLD. Those with type 2 had a more severe metabolic phenotype, with higher body mass index <jats:italic toggle=\"yes\">z<\/jats:italic> score (2.0 versus 1.6, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.0001), waist circumference centile (96th versus 90th, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.0001), and triglycerides (84 versus 77 mg\/dL, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.01) and lower high\u2010density lipoprotein (46 versus 60 mg\/dL, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.004) than those with type 1. Similarly, those with overlap NAFLD had a more severe phenotype. Stage 2\u20103 fibrosis was present in 69\/283 (24%) with overlap NAFLD. Portal inflammation was associated with stage 2\u20103 fibrosis on multivariable analysis (95% confidence interval 1.4\u20105.2, odds ratio = 3.7). Waist circumference centile was associated with portal inflammation (95% confidence interval 1.2\u20103.4, odds ratio = 2.0). <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic> Portal inflammation is associated with more advanced pediatric NAFLD and features of the metabolic syndrome. (H<jats:sc>epatology<\/jats:sc> 2016;63:745\u2013753)<\/jats:p>","DOI":"10.1002\/hep.28374","type":"journal-article","created":{"date-parts":[[2015,12,6]],"date-time":"2015-12-06T07:46:41Z","timestamp":1449388001000},"page":"745-753","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":79,"title":["Portal inflammation is independently associated with fibrosis and metabolic syndrome in pediatric nonalcoholic fatty liver disease"],"prefix":"10.1097","volume":"63","author":[{"given":"Jake P.","family":"Mann","sequence":"first","affiliation":[{"name":"Department of Paediatrics,University of Cambridge,Cambridge,UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita De","family":"Vito","sequence":"additional","affiliation":[{"name":"Histopathology Unit,Bambino Gesu Hospital, IRCCS,Rome,Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Mosca","sequence":"additional","affiliation":[{"name":"Hepatometabolic Unit,Bambino Gesu Hospital, IRCCS,Rome,Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Alisi","sequence":"additional","affiliation":[{"name":"Liver Research Unit,Bambino Gesu Hospital, IRCCS,Rome,Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"National Institute for Health Research, Birmingham Liver Biomedical Research Unit and Centre for Liver Research,University of Birmingham,Birmingham,UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Raponi","sequence":"additional","affiliation":[{"name":"Medical Directorate,Bambino Gesu Hospital, IRCCS,Rome,Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Baumann","sequence":"additional","affiliation":[{"name":"Paediatric Gastroenterology and Hepatology, Children's Hospital,Hannover Medical School,Hannover,Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Nobili","sequence":"additional","affiliation":[{"name":"Hepatometabolic Unit,Bambino Gesu Hospital, IRCCS,Rome,Italy"},{"name":"Liver Research Unit,Bambino Gesu Hospital, IRCCS,Rome,Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2016,1,14]]},"reference":[{"key":"hep28374-bib-0001-20241017","doi-asserted-by":"crossref","first-page":"5286","DOI":"10.3748\/wjg.v16.i42.5286","article-title":"Histopathology of nonalcoholic fatty liver disease","volume":"16","year":"2010","journal-title":"World J Gastroenterol"},{"key":"hep28374-bib-0002-20241017","first-page":"1538","article-title":"The 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