Sciarrillo Christina M, Short Kevin R, Keirns Bryant H, Elliott Destinee C, Clarke Stephen L, Palle Sirish, Emerson Sam R
Department of Nutritional Sciences, Oklahoma State University, Stillwater, Oklahoma, USA.
Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Pediatr Obes. 2023 Apr;18(4):e13007. doi: 10.1111/ijpo.13007. Epub 2023 Feb 3.
Better screening tools for paediatric NAFLD are needed. We tested the hypothesis that the postprandial triglyceride (TG) and fibroblast growth factor 19 (FGF19) response to an abbreviated fat tolerance test (AFTT) could differentiate adolescents with NAFLD from peers with obesity and normal weight.
Fifteen controls with normal weight (NW), 13 controls with obesity (OB) and 9 patients with NAFLD completed an AFTT. Following an overnight fast, participants consumed a high-fat meal. TG and FGF19 were measured at baseline and 4 h post-meal. Liver steatosis and fibrosis were measured via Fibroscan.
Fasting TG and FGF19 did not differ among groups; 4 h TG in the NAFLD and OB groups were greater (197 ± 69 mg/dL; 157 ± 72 mg/dL, respectively) than NW (105 ± 45 mg/dL; p < 0.05) and did not differ from one another. Within the entire cohort, 4 h TG were stratified by high and low steatosis. Adolescents with high steatosis had 98% greater 4 h TG than adolescents with low steatosis. 4 h FGF19, but not fasting FGF19, was higher in children with low steatosis compared with high steatosis (p < 0.05). Using area under the receiver operating curve (AUROC), the only biochemical outcome with diagnostic accuracy for NAFLD was 4 h TG (0.77 [95% CI: 0.60-0.94; p = 0.02]).
The postprandial TG response is increased in adolescents with obesity with hepatic steatosis, with or without NAFLD. Our preliminary analysis demonstrates 4 h TG differentiate patients with NAFLD from those without, supporting a role for the AFTT as a screening tool for paediatric NAFLD.
需要更好的儿童非酒精性脂肪性肝病（NAFLD）筛查工具。我们检验了这样一个假设，即餐后甘油三酯（TG）和成纤维细胞生长因子19（FGF19）对简化脂肪耐量试验（AFTT）的反应能够区分患有NAFLD的青少年与肥胖及体重正常的同龄人。
15名体重正常（NW）的对照者、13名肥胖（OB）对照者和9名NAFLD患者完成了AFTT。在禁食过夜后，参与者食用了一顿高脂肪餐。在基线和餐后4小时测量TG和FGF19。通过Fibroscan测量肝脏脂肪变性和纤维化。
各组间空腹TG和FGF19无差异；NAFLD组和OB组的4小时TG（分别为197±69mg/dL；157±72mg/dL）高于NW组（105±45mg/dL；p<0.05），且两组间无差异。在整个队列中，4小时TG按高、低脂肪变性分层。高脂肪变性的青少年4小时TG比低脂肪变性的青少年高98%。低脂肪变性儿童的4小时FGF19高于高脂肪变性儿童（p<0.05），而空腹FGF19无此差异。使用受试者工作特征曲线下面积（AUROC），唯一对NAFLD具有诊断准确性的生化指标是4小时TG（0.77[95%CI：0.60-0.94；p = 0.02]）。
无论有无NAFLD，伴有肝脂肪变性的肥胖青少年餐后TG反应均增加。我们的初步分析表明，4小时TG能够区分患有NAFLD的患者和未患NAFLD的患者，支持AFTT作为儿童NAFLD筛查工具的作用。
