Development and validation of a new histological score for pediatric non-alcoholic fatty liver disease

Naim Alkhouri, Rita De Vito, Anna Alisi, Lisa Yerian, Rocio Lopez, Ariel E. Feldstein, Valerio Nobili

Research output: Contribution to journalArticlepeer-review


Background & Aims: Pediatric non-alcoholic fatty liver disease (NAFLD) may present with a distinct histopathological pattern characterized by the presence of predominant portal-based injury and portal inflammation (PI). We aimed at developing a new grading score for pediatric NAFLD to be used in clinical trials that takes into account the presence of PI and the weight of histological features. Methods: Our training set consisted of 203 children with biopsy-proven NAFLD. The diagnosis of non-alcoholic steatohepatitis (NASH) was based on Brunt's criteria. Histological features were scored: steatosis (0-3), lobular inflammation (0-3), ballooning (0-2), and PI (0-2). Logistic regression analysis was performed to apply weight to each feature. The new score was called the Pediatric NAFLD Histological Score or PNHS. The validation set consisted of 100 children with NAFLD. Results: The mean age of the initial cohort was 12.4 ± 3.4 years and significant fibrosis (fibrosis stage ≥2) was present in 26 patients (12.8%). NASH was diagnosed in 135 patients with a mean NAS of 4.5 ± 1.4. The mean PNHS in the NASH group was 89 ± 20.5 compared to 21.9 ± 24.5 in the "not NASH" group, p

Original languageEnglish
Pages (from-to)1312-1318
Number of pages7
JournalJournal of Hepatology
Issue number6
Publication statusPublished - Dec 2012


  • Children
  • Histological score
  • Non-alcoholic fatty liver disease
  • Non-alcoholic steatohepatitis
  • Portal inflammation

ASJC Scopus subject areas

  • Hepatology


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