Department of Hepatology and Gastroenterology and Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Department of Hepatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong Province, China.
Eur J Pediatr. 2023 Feb;182(2):855-865. doi: 10.1007/s00431-022-04731-1. Epub 2022 Dec 12.
Obesity is a strong predictor for metabolic associated fatty liver disease (MAFLD), which has been associated with decreased insulin like growth factor 1 (IGF-1). In obesity, weight loss increases growth hormone secretion, but this is not unequivocally associated with increases in serum IGF-1 and IGF binding protein-3 (IGFBP-3). We studied the changes in the IGF axis in relation to weight loss and improvement in insulin resistance in children with or without MALFD after 10 weeks of lifestyle intervention at a weight loss camp (WLC). We investigated 113 (66 females) Caucasian children with obesity, median age 12.4 (range 7.3-14.6) years, before and after 10 weeks of lifestyle intervention at a WLC. We investigated children who was either MAFLD positive (n = 54) or negative (n = 59) before and after WLC. Children with MAFLD had lower baseline IGF-1 (249 ± 112 vs 278 ± 107 µg/l, P = 0.048), whereas the IGF-1/IGFBP-3 molar ratio was similar to children without MAFLD (19.4 ± 6.6 vs. 21.8 ± 6.6%, P = 0.108). When all children were considered as one group, WLC decreased SDS-BMI and HOMA-IR (P < 0.001, both) and increased IGF-1 (264 ± 110 vs 285 ± 108 µg/l, P < 0.001) and the IGF/IGFBP-3 molar ratio (20.7 ± 6.7 vs 22.4 ± 6.1%, P < 0.001). When categorized according to liver status, IGF-1 increased significantly in children with MAFLD (P = 0.008) and tended to increase in children without MAFLD (P = 0.052). Conclusions: Ten weeks of lifestyle intervention decreased insulin resistance and improved the IGF axis. We observed slight differences in the IGF axis in relation to MAFLD status. This suggests that the IGF axis is primarily influenced by insulin resistance rather than MAFLD status. What is New: • Weight loss decreases insulin resistance and subsequently increases the IGF axis in children with obesity. • Children with MAFLD had an aberration in the IGF axis compared to their MAFLD negative counter parts and the IGF axis was primarily influenced by the decreased BMI-SDS and insulin resistance, rather than MAFLD status. What is Known: • NAFLD has previously been associated with reduced serum IGF-1 concentrations. • Data on the impact of MAFLD and aberrations in the growth hormone and IGF axis and the effects of lifestyle interventions in children are limited.
肥胖是代谢相关脂肪性肝病（MAFLD）的一个强有力的预测因素，MAFLD 与胰岛素样生长因子 1（IGF-1）减少有关。在肥胖中，体重减轻会增加生长激素的分泌，但这并不明确与血清 IGF-1 和 IGF 结合蛋白 3（IGFBP-3）的增加有关。我们研究了在减肥夏令营（WLC）进行 10 周生活方式干预后，无论 MAFLD 是否存在，体重减轻和胰岛素抵抗改善与 IGF 轴的变化之间的关系。我们调查了 113 名（66 名女性）白种人肥胖儿童，中位年龄为 12.4 岁（范围为 7.3-14.6 岁），在 WLC 进行 10 周生活方式干预前后。我们调查了在 WLC 前后 MAFLD 阳性（n=54）或阴性（n=59）的儿童。MAFLD 儿童的基线 IGF-1 水平较低（249±112 与 278±107µg/l，P=0.048），而 IGF-1/IGFBP-3 摩尔比与非 MAFLD 儿童相似（19.4±6.6 与 21.8±6.6%，P=0.108）。当将所有儿童视为一个组时，WLC 降低了 SDS-BMI 和 HOMA-IR（P<0.001，均），并增加了 IGF-1（264±110 与 285±108µg/l，P<0.001）和 IGF/IGFBP-3 摩尔比（20.7±6.7 与 22.4±6.1%，P<0.001）。根据肝脏状态进行分类时，MAFLD 儿童的 IGF-1 显著增加（P=0.008），而非 MAFLD 儿童的 IGF-1 则有增加趋势（P=0.052）。结论：10 周的生活方式干预可降低胰岛素抵抗并改善 IGF 轴。我们观察到 IGF 轴与 MAFLD 状态有关的细微差异。这表明 IGF 轴主要受胰岛素抵抗影响，而不是 MAFLD 状态。新发现：• 体重减轻可降低肥胖儿童的胰岛素抵抗，并随后增加 IGF 轴。• MAFLD 儿童的 IGF 轴存在异常，与 MAFLD 阴性对照组相比，IGF 轴主要受 BMI-SDS 和胰岛素抵抗降低的影响，而不是 MAFLD 状态。已知内容：• 非酒精性脂肪性肝病（NAFLD）以前与血清 IGF-1 浓度降低有关。• 关于 MAFLD 和生长激素及 IGF 轴的异常以及生活方式干预对儿童的影响的数据有限。
