Issue link: https://viewer.e-digitaledition.com/i/155478
+++++++++++++++++ + +++ +PEDIATRICS U +++ +++++++++++++++++ 'Breathprint' Testing Emerges as Promising Method to Detect Fatty Liver Disease in Obese Children By Naim Alkhouri, MD N EARLY 20 PERCENT of U.S. children and adolescents from 2 to 19 years old are now obese. Well-known comorbidities of pediatric obesity include Type 2 diabetes, hypertension, dyslipidemia, sleep apnea, cardiovascular disease, asthma and nonalcoholic fatty liver disease (NAFLD). NAFLD is the most common form of chronic liver disease in childhood, affecting up to 50 percent of obese children. The condition is the hepatic manifestation of metabolic syndrome and should be suspected in all overweight or obese children and adolescents. The diagnosis of NAFLD traditionally has relied on blood testing, imaging studies and liver biopsy. With the epidemic of childhood obesity that is sweeping the nation and the high prevalence of NAFLD, noninvasive methods to identify children with NAFLD have been urgently needed. Now, a study presented earlier this year at Digestive Disease Week (DDW) in Orlando, Fla., has found that a quick and simple exhaled breath analysis is a promising, noninvasive method to detect fatty liver disease in obese children. The study found distinctive "breathprints" which can identify children with NAFLD with 90 percent accuracy. Advancements in Breath Testing The human body emits a wide array of volatile organic compounds (VOCs) in the breath that can be considered breathprints for each individual. Pathological conditions such as obesity and NAFLD can lead to the production of new VOCs or a change in the ratio of VOCs that are produced normally. Technological advancements in breath testing and analysis through gas and liquid chromatography and mass spectrometry have made it possible to identify hundreds of VOCs in the breath. While the creation of breath tests to diagnose specific conditions has become more widespread, research has focused primarily on adults. Breath testing enjoys major advantages in children because it is noninvasive and safe, and serial measurements are easy to obtain. had been diagnosed with NAFLD on ultrasound and 23 had a normal liver. The process of collecting a patient's breath for analysis is not unlike blowing up a balloon. Following specific protocols, children are asked to inhale to total lung capacity, followed by exhaling against 10 cm of water pressure into a collection bag at a constant flow. The bag is taken to the laboratory for analysis via mass spectrometry. The study found distinctive breathprints among children with NAFLD, with the concentrations of more than 15 VOCs differing significantly from children without NAFLD. Further analysis revealed that several key VOCs were higher in children with NAFLD. Researchers developed a predictive model composed of a number of the VOCs that correctly identified 90 percent of children with NAFLD (P<0.0001). One Child at a Time The early detection of NAFLD through a simple, noninvasive method has the potential to quickly, easily and accurately diagnose liver damage caused by obesity in pediatric patients. Future studies should focus on determining whether these results can be replicated and evaluating whether food or medication taken prior to testing has an effect on the results. The increasing prevalence of NAFLD in the pediatric population, in addition to many other known comorbidities of obesity, points to the importance of early intervention. Kids who are obese after age 6 are 50 percent more likely to be obese in adulthood. Clinical programs that include a multipronged approach to prevention and treatment can significantly improve the lives of at-risk children. Naim Alkhouri, MD, is the Clinical Director of the Pediatric Preventive Cardiology and Metabolic Clinic, Co-Director of the Be Well Kids Clinic, and Director of Research, Department of Pediatric Gastroenterology and Hepatology, Cleveland Clinic. I Source: Identifying NAFLD Biomarkers The recent study presented at DDW used recent advances in breath testing to investigate novel biomarkers for NAFLD in 60 overweight or obese children. Thirty-seven of the children 22 | Cleveland/Akron/Canton MD NEWS I MDNEWS.COM I SEPTEMBER- OCTOBER 2013 Alkhouri N, Cikach F, Eng K, et al. Analysis of breath volatile organic compounds as a noninvasive tool to diagnose nonalcoholic fatty liver disease in obese children. Presented at: Digestive Disease Week; Orlando, FL; May 18–21, 2013.