Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
Front Endocrinol (Lausanne). 2022 Dec 16;13:1071350. doi: 10.3389/fendo.2022.1071350. eCollection 2022.
Insulin resistance (IR), one of the key components of the metabolic syndrome, is recognized as the pathophysiological hallmark of non-alcoholic fatty liver disease (NAFLD). This study aims to investigate the relationship between surrogate markers of IR and the severity of NAFLD among overweight or obese children.
A total of 56 consecutive children aged 6 to 18 years old were recruited from the pediatric obesity and type 2 diabetes mellitus (T2DM) clinic in University Malaya Medical Centre (UMMC) from 2016 to 2019. Data on anthropometric measurements, clinical components of metabolic syndrome and fasting serum insulin were collected. Triglyceride to high-density lipoprotein cholesterol ratio (TG: HDL-C), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and Single Point Insulin Sensitivity Estimator (SPISE) were calculated. Transient elastography was performed with hepatic steatosis and liver fibrosis assessed by controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively.
A total of 44 children (78.6%) had liver steatosis and 35.7% had presence of significant liver fibrosis (stage F≥2). Majority (89.3%) are obese and 24 children (42.9%) were diagnosed with metabolic syndrome. Higher number of children with T2DM and significant liver fibrosis were associated with higher tertiles of TG: HDL-C ratio (p<0.05). Top tertile of TG: HDL-C ratio was an independent predictor of liver fibrosis (OR=8.14, 95%CI: 1.24-53.36, p=0.029). ROC analysis showed that the area under the curve (AUC) of HOMA-IR (0.77) and TG: HDL-C ratio (0.71) were greater than that of metabolic syndrome (0.70), T2DM (0.62) and SPISE (0.22). The optimal cut-off values of HOMA-IR and TG: HDL-C ratio for detecting liver fibrosis among children with NAFLD are 5.20 and 1.58, respectively.
Children with NAFLD and higher TG: HDL-C ratio are more likely to have liver fibrosis. TG: HDL-C ratio is a promising tool to risk stratify those with NAFLD who are at risk of developing advanced liver disease.
胰岛素抵抗（IR）是代谢综合征的关键组成部分之一，被认为是非酒精性脂肪性肝病（NAFLD）的病理生理学标志。本研究旨在探讨超重或肥胖儿童中 IR 的替代标志物与 NAFLD 严重程度之间的关系。
2016 年至 2019 年，我们从马来西亚大学医学中心（UMMC）儿科肥胖和 2 型糖尿病（T2DM）诊所招募了 56 名年龄在 6 至 18 岁的连续儿童。收集了人体测量学测量、代谢综合征的临床成分和空腹血清胰岛素的数据。计算了甘油三酯与高密度脂蛋白胆固醇比值（TG：HDL-C）、稳态模型评估的胰岛素抵抗（HOMA-IR）和单点胰岛素敏感性估计值（SPISE）。使用受控衰减参数（CAP）和肝硬度测量（LSM）分别评估肝脂肪变性和肝纤维化，进行瞬时弹性成像。
共有 44 名儿童（78.6%）存在肝脂肪变性，35.7%存在显著肝纤维化（F 期≥2）。大多数（89.3%）肥胖，24 名儿童（42.9%）被诊断为代谢综合征。T2DM 和显著肝纤维化的儿童数量较高与 TG：HDL-C 比值的较高三分位数相关（p<0.05）。TG：HDL-C 比值的最高三分位数是肝纤维化的独立预测因子（OR=8.14，95%CI：1.24-53.36，p=0.029）。ROC 分析显示，HOMA-IR（0.77）和 TG：HDL-C 比值（0.71）的曲线下面积（AUC）大于代谢综合征（0.70）、T2DM（0.62）和 SPISE（0.22）。HOMA-IR 和 TG：HDL-C 比值检测儿童 NAFLD 肝纤维化的最佳截断值分别为 5.20 和 1.58。
患有 NAFLD 和较高 TG：HDL-C 比值的儿童更有可能发生肝纤维化。TG：HDL-C 比值是一种很有前途的工具，可以对有发生进展性肝病风险的 NAFLD 患者进行风险分层。
