Department of Pediatrics, Kuo General Hospital, Tainan, Taiwan.
J Pediatr Gastroenterol Nutr. 2013 Feb;56(2):145-50. doi: 10.1097/MPG.0b013e3182722aee.
Nonalcoholic fatty liver disease (NAFLD) is identified as a major liver disease in children. The present study aimed to identify the prevalence and predictors of pediatric NAFLD and the correlation between serum retinol-binding protein 4 (RBP4) levels and metabolic characteristics in children.
A total of 748 schoolchildren, ages 6 to 12 years, were enrolled in 2009. The body weight and height were measured in the morning before intake. Laboratory tests included overnight fasting serum lipids, insulin, liver enzymes, and RBP4 levels. Hepatic steatosis was determined by ultrasound in 219 volunteers.
The rates of NAFLD were 3% in the normal-weight, 25% in the overweight, and 76% in the obese children. Twenty (22%) of obese children had abnormal alanine aminotransferase (ALT) levels. In children with NAFLD, younger age and higher body mass index (BMI), insulin/homeostasis model of assessment, and male sex rate were associated with abnormal liver function. Stepwise increments in BMI, insulin, homeostasis model of assessment, and ALT were found in children with normal livers to simple steatosis, and to steatosis with abnormal ALT. Multiple logistic regression analysis confirmed that serum RBP4 levels (P = 0.048), ALT (P = 0.048), and BMI (P < 0.001) were independently predictors of pediatric NAFLD. Moreover, multiple linear regression analysis revealed that only serum triglycerides levels were positively related to RBP4 levels (P < 0.001).
Higher RBP4 and ALT levels as well as BMI are independently associated with pediatric NAFLD in Taiwan. In addition, an increment in RBP4 levels was positively correlated to hypertriglyceridemia in children.
非酒精性脂肪性肝病（NAFLD）被认为是儿童的一种主要肝脏疾病。本研究旨在确定儿童 NAFLD 的患病率和预测因素，以及血清视黄醇结合蛋白 4（RBP4）水平与儿童代谢特征之间的相关性。
共纳入 2009 年 748 名 6 至 12 岁的学龄儿童。所有研究对象均于清晨空腹测量体重和身高。实验室检测包括过夜禁食血清脂质、胰岛素、肝酶和 RBP4 水平。219 名志愿者通过超声检查确定肝脏脂肪变性。
正常体重、超重和肥胖儿童的 NAFLD 患病率分别为 3%、25%和 76%。20 名（22%）肥胖儿童的丙氨酸氨基转移酶（ALT）水平异常。在患有 NAFLD 的儿童中，年龄较小、体重指数（BMI）较高、胰岛素/稳态模型评估值较高和男性比例较高与肝功能异常相关。在肝脏正常、单纯脂肪变性和伴有 ALT 异常的脂肪变性的儿童中，BMI、胰岛素、稳态模型评估值和 ALT 呈逐步递增。多因素 logistic 回归分析证实，血清 RBP4 水平（P=0.048）、ALT（P=0.048）和 BMI（P<0.001）是儿童 NAFLD 的独立预测因素。此外，多元线性回归分析显示，只有血清三酰甘油水平与 RBP4 水平呈正相关（P<0.001）。
在台湾，较高的 RBP4 和 ALT 水平以及 BMI 与儿童 NAFLD 独立相关。此外，RBP4 水平的升高与儿童高甘油三酯血症呈正相关。
