Dâmaso A R, do Prado W L, de Piano A, Tock L, Caranti D A, Lofrano M C, Carnier J, Cristofalo D J M, Lederman H, Tufik S, de Mello M T
Post Graduate Program of Nutrition, Federal University of São Paulo, Paulista Medicine School, UNIFESP-EPM, Brazil.
Dig Liver Dis. 2008 Feb;40(2):132-9. doi: 10.1016/j.dld.2007.09.009. Epub 2007 Dec 21.
Visceral adiposity is the major risk factor for paediatric nonalcoholic fatty liver disease.
Determine the prevalence of nonalcoholic fatty liver disease according to the visceral fat quartile.
181 obese adolescents including 113 girls (16.58+/-1.56 years) and 68 boys (16.87+/-1.62 years) were evaluated.
The inclusion criteria were obesity and post-pubertal stage of Tanner. Visceral fat of obese adolescents was distributed in quartiles after ultrasound nonalcoholic fatty liver disease diagnosis.
Nonalcoholic fatty liver disease prevalence was 45.30%. It was observed that 62.07% and 76.47% of girls and boys with nonalcoholic fatty liver disease were found in the 4th quartile. In a multivariate logistic analysis it was observed that only visceral fat remained statistically significant, every 1cm increase in visceral fat was associated with a 1.97 fold (95% CI 1.06-3.66) in boys and 2.08 fold (95% CI 1.38-3.13) in girls increased risk to develop nonalcoholic fatty liver disease. Indeed it was verified a positive correlation between visceral fat, body mass index, insulin levels, homeostasis model assessment insulin resistance index and steatosis degree.
Our findings suggested that the expansion of visceral fat was a determinant factor to increase nonalcoholic fatty liver disease prevalence and the visceral fat measured by ultrasound might be a good predictor to identify risk for nonalcoholic fatty liver disease in obese adolescents. It was confirmed by a stronger correlation between visceral fat and body mass index.
内脏脂肪过多是儿童非酒精性脂肪性肝病的主要危险因素。
根据内脏脂肪四分位数确定非酒精性脂肪性肝病的患病率。
对181名肥胖青少年进行了评估，其中包括113名女孩（16.58±1.56岁）和68名男孩（16.87±1.62岁）。
纳入标准为肥胖和坦纳青春期后期。在超声诊断非酒精性脂肪性肝病后，将肥胖青少年的内脏脂肪分为四分位数。
非酒精性脂肪性肝病的患病率为45.30%。观察发现，患有非酒精性脂肪性肝病的女孩和男孩中，分别有62.07%和76.47%处于第4四分位数。在多因素逻辑分析中观察到，只有内脏脂肪仍具有统计学意义，内脏脂肪每增加1厘米，男孩患非酒精性脂肪性肝病的风险增加1.97倍（95%可信区间1.06 - 3.66），女孩增加2.08倍（95%可信区间1.38 - 3.13）。事实上，已证实内脏脂肪、体重指数、胰岛素水平、稳态模型评估胰岛素抵抗指数和脂肪变性程度之间存在正相关。
我们的研究结果表明，内脏脂肪增加是导致非酒精性脂肪性肝病患病率上升的决定性因素，超声测量的内脏脂肪可能是识别肥胖青少年非酒精性脂肪性肝病风险的良好预测指标。内脏脂肪与体重指数之间更强的相关性证实了这一点。
