Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 8, 2017; 9(16): 746-751
Published online Jun 8, 2017. doi: 10.4254/wjh.v9.i16.746
Low bone mineral density and the severity of cholestasis in biliary atresia
Krittapak Homchan, Tawatchai Chaiwatanarat, Wanvisa Udomsinprasert, Voranush Chongsrisawat, Yong Poovorawan, Sittisak Honsawek
Krittapak Homchan, Voranush Chongsrisawat, Yong Poovorawan, Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
Tawatchai Chaiwatanarat, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Wanvisa Udomsinprasert, Sittisak Honsawek, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Author contributions: Homchan K carried out laboratory work, collected the data, and analyzed the data; Udomsinprasert W collected blood samples and assisted in analysis of data; Chaiwatanarat T, Chongsrisawat V and Poovorawan Y examined all the patients and collected clinical data; Honsawek S designed the study, carried out laboratory work, analyzed the data, wrote the manuscript, and revised the manuscript for final submission.
Supported by The Thailand Research Fund (RSA 5880019); the Research Chair Grant from the National Science and Technology Development Agency; and National Research University Project, through the Ageing Cluster (NRU59-056-AS), Chulalongkorn University.
Institutional review board statement: This study was approved by the Institutional Review Board on Human Research of the Faculty of Medicine, Chulalongkorn University.
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at sittisak.h@chula.ac.th. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sittisak Honsawek, MD, PhD, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Road, Patumwan, Bangkok 10330, Thailand. sittisak.h@chula.ac.th
Telephone: +66-2-2564482 Fax: +66-2-2564482
Received: January 30, 2017
Peer-review started: February 12, 2017
First decision: March 28, 2017
Revised: April 19, 2017
Accepted: May 12, 2017
Article in press: May 15, 2017
Published online: June 8, 2017
Abstract
AIM

To investigate the prevalence of osteopenia and osteoporosis in postoperative biliary atresia (BA) children and the association of bone mineral density (BMD) and biochemical parameters in postKasai BA subjects.

METHODS

A total of 70 patients with postKasai BA were enrolled in this prospective study. The patients were classified into two groups according to their jaundice status. BMD of the lumbar spine was analyzed using dual energy X-ray absorptiometry.

RESULTS

The prevalence of low bone mass (osteopenia and osteoporosis) in BA patients were 51.4% (36 out of 70). Ten patients (35.7%) in the jaundice group and 8 patients (19.0%) in the non-jaundice group had osteopenia. Sixteen patients (57.1%) in the jaundice group and 2 patients (4.8%) in the no jaundice group had osteoporosis. In addition, lumbar spine BMD Z-score was substantially lower in the jaundice BA patients compared with non-jaundice patients. BA subjects with persistent jaundice had significantly lower serum 25-hydroxyvitamin D than those without jaundice. Further analysis revealed that lumbar spine BMD was correlated with age (r = 0.774, P < 0.001), serum albumin (r = 0.333, P = 0.005), total bilirubin (r = -0.476, P < 0.001), aspartate aminotransferase (r = -0.583, P < 0.001), alanine aminotransferase (r = -0.428, P < 0.001), and alkaline phosphatase(r = -0.456, P < 0.001).

CONCLUSION

Low BMD was associated with biochemical parameters reflecting the severity of cholestasis in postKasai BA patients.

Keywords: Bone mineral density, Jaundice, Biliary atresia, Cholestasis, Severity

Core tip: Recent evidences have highlighted the importance of bone mineral density (BMD) in chronic liver disease including biliary atresia (BA). This study revealed that BA patients with persistent jaundice had significantly lower BMD and 25-hydroxyvitamin D than those without jaundice. Furthermore, lumbar spine BMD was correlated with hepatic dysfunction suggesting that low BMD was associated with outcome parameters reflecting the severity of cholestasis in postoperative BA patients.