Lin Yu-Cheng, Chang Pi-Feng, Liu Kevin, Chang Mei-Hwei, Ni Yen-Hsuan
Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Oriental Institute of Technology, New Taipei City, Taiwan.
Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
J Formos Med Assoc. 2022 Jan;121(1 Pt 1):36-42. doi: 10.1016/j.jfma.2021.01.004. Epub 2021 Jan 24.
BACKGROUND/PURPOSE: The status of nonalcoholic fatty liver disease (NAFLD) can wax and wane over time in children. However, the factors affecting its incidence and remission remain elusive. We aimed to investigate NAFLD incidence, remission and predicting factors in obese children.
Obese children aged 9-10 and 12-13 years were recruited from schools and followed up for 2 years. Liver ultrasonography was performed at baseline and Year 1. Alanine aminotransferase (ALT) concentrations were measured at baseline, Year 1 and Year 2. Elevated ALT was defined as above 26 U/L for boys and 22 U/L for girls. Four NAFLD susceptible genes, including PNPLA3, GCKR, TM6SF2 and MBOAT7, were genotyped. We analyzed the effects of these risk factors on the incidence and remission of NAFLD and elevated ALT.
At baseline, 86 of 440 (19.5%) subjects had ultrasonography-diagnosed NAFLD. At Year 1, of 264 subjects without NAFLD at baseline, 20 (7.6%) developed NAFLD. The baseline BMI z-score and increment in BMI z-score independently predicted incident NAFLD. Of the 68 subjects with NAFLD at baseline, 36 (52.9%) had NAFLD remission. Decrement in BMI z-score independently predicted NAFLD remission. The four studied NAFLD susceptible genes were not significantly associated with either the incidence or remission of NAFLD. In addition, changes in BMI z-score predicted the incidence and remission of elevated ALT from Year 1 to Year 2.
Obese children with increasing BMI are more likely to develop NAFLD and those with decreasing BMI are more likely to have NAFLD remission.
背景/目的：儿童非酒精性脂肪性肝病（NAFLD）的病情会随时间波动。然而，影响其发病率和缓解的因素仍不明确。我们旨在调查肥胖儿童中NAFLD的发病率、缓解情况及预测因素。
从学校招募9 - 10岁和12 - 13岁的肥胖儿童，并随访2年。在基线和第1年进行肝脏超声检查。在基线、第1年和第2年测量丙氨酸氨基转移酶（ALT）浓度。ALT升高定义为男孩高于26 U/L，女孩高于22 U/L。对包括PNPLA3、GCKR、TM6SF2和MBOAT7在内的4个NAFLD易感基因进行基因分型。我们分析了这些危险因素对NAFLD发病率、缓解情况及ALT升高的影响。
基线时，440名受试者中有86名（19.5%）经超声诊断为NAFLD。在第1年，基线时无NAFLD的264名受试者中有20名（7.6%）患NAFLD。基线BMI z评分和BMI z评分增量独立预测新发NAFLD。基线时有NAFLD的68名受试者中，36名（52.9%）NAFLD缓解。BMI z评分下降独立预测NAFLD缓解。所研究的4个NAFLD易感基因与NAFLD的发病率或缓解均无显著关联。此外，BMI z评分的变化预测了第1年至第2年ALT升高的发病率和缓解情况。
BMI增加的肥胖儿童更易发生NAFLD，而BMI降低的儿童更易出现NAFLD缓解。
