Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA.
Seattle Children's Research Institute, Center for Clinical and Translational Research, Seattle, Washington, USA.
Horm Res Paediatr. 2017;88(3-4):265-273. doi: 10.1159/000479868. Epub 2017 Sep 12.
Obesity is strongly associated with insulin resistance, hypertension, dyslipidemia, and therefore risk for metabolic syndrome (MetS), which is an increasing problem in youth. The potential role of elevated liver enzyme levels in this context needs to be further investigated.
This paper provides a post hoc analysis of a cross-sectional study of 77 obese nondiabetic children (51% female; median age 11.7 years; BMI >97th percentile) enrolled at the University of Bonn, Bonn, Germany. Anthropometric parameters, lipid profiles, glycemic control, and liver enzyme levels were evaluated. Glucose and insulin levels were determined during an oral glucose tolerance test (OGTT). Gender- and age-specific cutoff values were used to assess MetS.
A high prevalence of hypertension (51%), dyslipidemia (52%), elevated liver enzyme levels (51%), and hyperglycemia (24%) was found. There was considerable overlap between the presence of different MetS risk factors in individuals, and 40% of the participants had ≥3 of a maximum of 5 MetS risk factors. Elevated liver enzyme levels were significantly associated with reduced insulin sensitivity, as the OGTT-insulin response was significantly higher in participants with elevated transaminases (p = 0.01). This association was independent of hyperglycemia and dyslipidemia (p = 0.03).
We conclude that liver enzyme levels are related to insulin sensitivity in obese children and could therefore be an indirect indicator for MetS. Testing for disturbed glucose metabolism should be considered for obese children with elevated liver enzymes.
肥胖与胰岛素抵抗、高血压、血脂异常密切相关，因此存在代谢综合征（MetS）的风险，这在年轻人中是一个日益严重的问题。需要进一步研究肝酶水平升高在此背景下的潜在作用。
本文对德国波恩大学的一项肥胖非糖尿病儿童（51%为女性；中位年龄 11.7 岁；BMI>97 百分位）的横断面研究进行了事后分析。评估了人体测量参数、血脂谱、血糖控制和肝酶水平。在口服葡萄糖耐量试验（OGTT）期间测定血糖和胰岛素水平。使用性别和年龄特异性截断值评估 MetS。
发现高血压（51%）、血脂异常（52%）、肝酶水平升高（51%）和高血糖（24%）的患病率很高。个体中不同 MetS 危险因素的存在存在相当大的重叠，40%的参与者有≥5 个 MetS 危险因素中的 3 个以上。肝酶水平升高与胰岛素敏感性降低显著相关，因为转氨酶升高的参与者 OGTT 胰岛素反应显著更高（p=0.01）。这种关联独立于高血糖和血脂异常（p=0.03）。
我们得出结论，肝酶水平与肥胖儿童的胰岛素敏感性相关，因此可能是 MetS 的间接指标。对于肝酶升高的肥胖儿童，应考虑检测葡萄糖代谢紊乱。
