Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, Okinawa Chubu Hospital, Okinawa, Japan; Department of Clinical Research and Quality Management, University of the Ryukyus Graduate School of Medicine, Okinawa, Japan.
Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Nutrition. 2021 Nov-Dec;91-92:111447. doi: 10.1016/j.nut.2021.111447. Epub 2021 Aug 10.
The objective of this study was to investigate the association between measures of body composition based on bioelectrical impedance analysis (BIA) and histologic severity of liver disease in a pediatric cohort with nonalcoholic fatty liver disease (NAFLD).
This was a cross-sectional study of patients < 20 y old with histologically confirmed NAFLD followed in our Steatohepatitis Center from 2017 to 2019. Contemporaneous body-composition data were obtained using a multifrequency octopolar BIA device (InBody 370, InBody, Seoul, South Korea). BIA data collected were skeletal muscle mass, appendicular muscle mass, and percentage body fat. Skeletal and appendicular muscle mass were corrected for height (dividing by the square of height), generating their respective indices. Univariate linear and logistic regression, followed by multivariable logistic regression analyses, were used.
Of the 79 children included (27% female, 73% male; 38% Hispanic; median age, 13 y; median body mass index Z-score, 2.43), the median NAFLD Activity Score was 4 (interquartile range, 3-5). In multivariable regression analyses, the skeletal muscle mass index was negatively associated with hepatic steatosis after controlling for confounders (odds ratio, 0.76; 95% confidence interval, 0.62-0.93). Similarly, the appendicular muscle mass index was negatively associated with severity of hepatic steatosis severity (odds ratio, 0.69; 95% confidence interval, 0.53-0.90). In contrast, percentage body fat was not associated with hepatic steatosis. NAFLD Activity Score, lobular inflammation, ballooning scores, and fibrosis stage were not associated with measures of body composition.
There is an inverse association between BIA-based measures of muscle mass and severity of hepatic steatosis in children with NAFLD. BIA data could further inform clinical decision making in this context.
本研究旨在探讨基于生物电阻抗分析（BIA）的人体成分测量与非酒精性脂肪性肝病（NAFLD）患儿肝脏疾病组织学严重程度之间的关系。
这是一项横断面研究，纳入了 2017 年至 2019 年在我们的脂肪性肝炎中心接受组织学证实的 NAFLD 治疗的<20 岁患者。使用多频八电极 BIA 设备（InBody 370，InBody，韩国首尔）同期获得人体成分数据。BIA 数据包括骨骼肌量、四肢骨骼肌量和体脂百分比。骨骼肌量和四肢骨骼肌量通过身高（除以身高的平方）进行校正，生成各自的指数。采用单变量线性和逻辑回归，随后进行多变量逻辑回归分析。
在纳入的 79 名儿童中（27%为女性，73%为男性；38%为西班牙裔；中位年龄为 13 岁；中位 BMI Z 评分 2.43），NAFLD 活动评分中位数为 4（四分位距，3-5）。在多变量回归分析中，在校正混杂因素后，骨骼肌质量指数与肝脂肪变性呈负相关（比值比，0.76；95%置信区间，0.62-0.93）。同样，四肢骨骼肌质量指数与肝脂肪变性严重程度呈负相关（比值比，0.69；95%置信区间，0.53-0.90）。相比之下，体脂百分比与肝脂肪变性无关。NAFLD 活动评分、小叶炎症、气球样变评分和纤维化分期与人体成分测量值均无关。
在患有 NAFLD 的儿童中，基于 BIA 的肌肉量测量与肝脂肪变性严重程度呈负相关。BIA 数据可以在这种情况下进一步为临床决策提供信息。
