Department of Pediatric Endocrinology, Ankara University School of Medicine, Ataturk Sıtesi 15th Block No. 21 Flat 7 Door Number 14 Oran, Ankara, Turkey.
Department of Family Medicine, Samsun Obstetrics and Children Hospital, Samsun, Turkey.
Hormones (Athens). 2019 Dec;18(4):477-484. doi: 10.1007/s42000-019-00152-2. Epub 2019 Nov 21.
Non-alcoholic fatty liver disease (NAFLD) and associated morbidities have become a major public health problem, with a global three-fold increase in incidence among obese children over the last three decades. Although the gold standard for diagnosis of NAFLD is liver biopsy, it is not widely used in children. Imaging techniques, including magnetic resonance imaging (MRI) and ultrasound (US), can provide information on liver fat deposition, however, with variable sensitivity. A number of other predictors are therefore being investigated for pediatric screening and diagnostic purposes. The aim of this study was to assess easily measured parameters to prompt further investigation into NAFLD in obese children.
Obese children/adolescents with a body mass index (BMI) percentile > 95 were enrolled in the study (n = 353). After a 12-hour fast, venous glucose, insulin, cholesterol, triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and uric acid were measured and a full blood count was performed in all subjects. TG/LDL ratio, AST/platelet ratio index (APRI score), and homeostatic model of assessment for insulin resistance (HOMA-IR) were calculated. All patients underwent an abdominal US examination to assess hepatosteatosis.
Of 353 patients, median age 12.5 (range, 6-17.9) years, 210 patients (59%) had US-proven hepatosteatosis. Female gender reduced the risk of steatosis 2.08-fold (p = 0.005), a one-unit increase in HDL reduced the risk of steatosis 1.02-fold (p = 0.042), and a one-unit increase in BMI led to a 1.11-fold (p = 0.002) increase in the risk of steatosis.
Gender, BMI, and HDL were found to be predictors of steatosis. Male patients with low HDL and high BMI are at greater risk of steatosis and should be carefully examined for the presence of NAFLD.
非酒精性脂肪性肝病（NAFLD）及其相关并发症已成为一个主要的公共卫生问题，在过去三十年中，肥胖儿童的发病率全球增加了三倍。虽然肝活检是诊断 NAFLD 的金标准，但在儿童中并不广泛使用。影像学技术，包括磁共振成像（MRI）和超声（US），可以提供关于肝脂肪沉积的信息，但敏感性不同。因此，正在研究许多其他预测因素，用于儿科筛查和诊断目的。本研究旨在评估易于测量的参数，以提示进一步调查肥胖儿童的 NAFLD。
本研究纳入了体质量指数（BMI）百分位>95 的肥胖儿童/青少年（n=353）。所有受试者均空腹 12 小时后，检测静脉血糖、胰岛素、胆固醇、甘油三酯（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）和尿酸，并进行全血细胞计数。计算 TG/LDL 比值、天冬氨酸氨基转移酶/血小板比值指数（APRI 评分）和胰岛素抵抗的稳态模型评估（HOMA-IR）。所有患者均行腹部超声检查以评估肝脂肪变性。
353 例患者中，中位年龄 12.5（范围 6-17.9）岁，210 例（59%）患者超声证实存在肝脂肪变性。女性使脂肪变性的风险降低 2.08 倍（p=0.005），HDL 每增加 1 单位，脂肪变性的风险降低 1.02 倍（p=0.042），BMI 每增加 1 单位，脂肪变性的风险增加 1.11 倍（p=0.002）。
性别、BMI 和 HDL 是脂肪变性的预测因素。女性、HDL 低和 BMI 高的男性患者发生脂肪变性的风险更高，应仔细检查是否存在 NAFLD。
