Background: Childhood acute lymphoblastic leukaemia (ALL) survivors have an increased risk of metabolic and
cardiovascular disease. We aimed to assess the presence of non-alcoholic fatty liver disease (NAFLD) in childhood ALL
and if it is associated with early cardiovascular dysfunction.
Methods: In total, 53 childhood ALL survivors and 34 controls underwent auxological evaluation, biochemical assay,
liver, heart and vascular ultrasound study.
Results: NAFLD was more frequent in ALL patients than in controls (39.6% vs 11.7%, P < 0.01). Patients with NAFLD
were more obese and insulin resistant than patients without NAFLD. Flow-mediated dilatation and interventricular
septum were lower in the ALL group than those in the control group (P < 0.001 for both). The patients with NAFLD
showed lower left ventricular ejection fraction than those without NAFLD (P = 0.011). In ALL survivors, BMI-SDS and
subcutaneous fat were the strongest predictors of NAFLD, whereas preperitoneal adipose tissue and C-reactive protein
were the strongest predictors of left ventricular ejection fraction.
Conclusions: Childhood ALL survivors had higher prevalence of NAFLD than healthy controls, which is associated
with early left ventricular impairment. In the case of fatty liver, a comprehensive heart evaluation is mandatory. We
strongly recommend to prevent visceral adiposity in ALL survivors, to search for metabolic
syndrome or its components and to reinforce the need of intervention on diet and lifestyle
during the follow-up of these patients