Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH.
Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
J Pediatr. 2022 Nov;250:61-66.e1. doi: 10.1016/j.jpeds.2022.07.004. Epub 2022 Jul 11.
To investigate the prevalence and characteristics of children with nonalcoholic fatty liver disease (NAFLD) who reduce their body mass index (BMI) z-score (BMIz) by >.25, a goal in obesity medicine, and to determine the BMIz decrease needed for serum aminotransferase normalization.
This retrospective, single-center study included patients aged <18 years followed for NAFLD. Patients who had undergone weight loss surgery or had other reasons for weight loss/gain were excluded. Logistic regression was used to determine the odds of achieving a BMIz change of >-.25, as well as predictors of this outcome.
Of the 784 children who met the study criteria (median age, 13 years; 66% male; 24% Hispanic), 541 had a lowest BMIz at >90 days following the baseline clinic visit. Of these children, 168 (31%) had a BMIz change of >-.25 from baseline over a median of 367 days (IQR, 201-678 days). Decreases in serum aminotransferase and lipid levels were seen in both groups (with and without a BMIz change of >-.25); however, these decreases were more pronounced in children who achieved a BMIz drop of >.25. Hemoglobin A1c concentration did not change in either group. Young age (OR, .861; 95% CI, .81-.92; P < .01) and non-Hispanic ethnicity (OR of non-Hispanic vs Hispanic, .61; 95% CI, .38-.97; P < .04) were predictors of a BMIz change >-.25. The BMIz decrease associated with normalization of serum alanine aminotransferase was .27.
A BMIz reduction of >.25 is associated with significant changes in serum aminotransferase levels. These findings can further guide the clinical management of children with NAFLD.
调查体质量指数（BMI）z 评分（BMIz）降低幅度超过 0.25 的非酒精性脂肪性肝病（NAFLD）患儿的患病率和特征，这是肥胖医学的一个目标，并确定血清氨基转移酶正常化所需的 BMIz 降低幅度。
这项回顾性单中心研究纳入了接受 NAFLD 随访的年龄<18 岁的患者。排除了接受减肥手术或有其他减肥/增重原因的患者。使用逻辑回归确定 BMIz 变化幅度超过-.25 的几率，以及该结果的预测因素。
在符合研究标准的 784 名儿童中（中位年龄 13 岁；66%为男性；24%为西班牙裔），541 名儿童的最低 BMIz 出现在基线就诊后>90 天。在这些儿童中，有 168 名（31%）在中位时间为 367 天（IQR，201-678 天）的时间内 BMIz 从基线值降低幅度超过-.25。两组儿童的血清氨基转移酶和血脂水平均降低（有和无 BMIz 变化幅度超过-.25）；然而，在 BMIz 降低幅度超过 0.25 的儿童中，这些降低更为明显。两组儿童的血红蛋白 A1c 浓度均未发生变化。年龄较小（OR，0.861；95%CI，0.81-.92；P<.01）和非西班牙裔种族（非西班牙裔与西班牙裔的 OR，0.61；95%CI，0.38-.97；P<.04）是 BMIz 变化幅度超过-.25 的预测因素。与血清丙氨酸氨基转移酶正常化相关的 BMIz 降低幅度为 0.27。
BMIz 降低幅度超过 0.25 与血清氨基转移酶水平的显著变化相关。这些发现可以进一步指导 NAFLD 患儿的临床管理。
