Gastroenterology Unit, Costa del Sol Sanitary Agency; Research Unit, Research Network of Health Services in Chronic Diseases-REDISSEC, Marbella.
J Gastroenterol Hepatol. 2013 Sep;28(9):1532-8. doi: 10.1111/jgh.12276.
Obesity is an important health-care problem in developed countries. It is considered a multisystemic disease, but it may also affect the liver, thus provoking non-alcoholic fatty liver disease. This disease has been less extensively studied among children than among adults. We propose to analyze the prevalence of hepatic steatosis among a pediatric population within an area in southern Europe besides the variables associated with its development and severity.
Cross-sectional study carried out on a population of children aged 6-14 years inclusive, using abdominal ultrasound as a method to determine the presence and severity of hepatic steatosis; in addition, anthropometric and blood-tested parameters were examined to determine which of these were associated with steatosis.
One hundred forty-four children were analyzed, 84 male (58.3%). Steatosis was detected in 50 children (34.7%; 95% confidence interval [CI]: 26.0-42.0%). In six of these cases (12%), elevated aminotransferase levels were recorded. Factors found to be associated with steatosis were body mass index ≥ 99th percentile (odds ratio [OR] 3.58, 95% CI 1.16-15.6) and the level of alanine aminotransferase (ALT) (OR 1.08, 95% CI 1.03-1.13), while its severity was associated with ALT (OR 1.17, 95% CI 1.09-1.28). A level of ALT < 23.5 UI/dL predicted lack of severe steatosis with an area under receiver operating characteristic curve of 0.805 (95% CI 0.683-0.927).
Non-alcoholic fatty liver disease is common in the obese pediatric population in our geographical area. High levels of ALT are associated with severe steatosis, although having ALT above the normal range is not common. Also, the lack of severity of steatosis can be predicted in a subgroup of children with obesity.
肥胖是发达国家的一个重要医疗保健问题。它被认为是一种多系统疾病，但也可能影响肝脏，从而引发非酒精性脂肪性肝病。这种疾病在儿童中的研究不如在成人中广泛。我们建议分析欧洲南部一个地区的儿科人群中肝脂肪变性的患病率，以及与肝脂肪变性的发展和严重程度相关的变量。
对年龄在 6-14 岁之间的儿童进行横断面研究，使用腹部超声作为确定肝脂肪变性存在和严重程度的方法；此外，还检查了人体测量和血液测试参数，以确定哪些参数与脂肪变性有关。
共分析了 144 名儿童，其中男性 84 名（58.3%）。在 50 名儿童（34.7%；95%置信区间[CI]：26.0-42.0%）中发现脂肪变性。在其中 6 例（12%）中，记录到转氨酶升高。与脂肪变性相关的因素有体重指数≥第 99 百分位数（比值比[OR] 3.58，95%CI 1.16-15.6）和丙氨酸转氨酶（ALT）水平（OR 1.08，95%CI 1.03-1.13），而其严重程度与 ALT 相关（OR 1.17，95%CI 1.09-1.28）。ALT<23.5 UI/dL 预测严重脂肪变性缺乏，受试者工作特征曲线下面积为 0.805（95%CI 0.683-0.927）。
在我们的地理区域，肥胖的儿科人群中非酒精性脂肪性肝病很常见。高水平的 ALT 与严重脂肪变性相关，尽管 ALT 高于正常范围并不常见。此外，肥胖儿童亚组可以预测脂肪变性的严重程度。
