Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Wuhan Wuchang Hospital, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan University of Science and Technology, Wuhan, Hubei, China.
Front Endocrinol (Lausanne). 2023 Aug 31;14:1224816. doi: 10.3389/fendo.2023.1224816. eCollection 2023.
This study aimed to determine the clinical characteristics of obese pediatric non-alcoholic fatty liver disease (NAFLD) in central China and verify the applicability of some known risk factors for pediatric NAFLD before late puberty.
This was a retrospective case-control study. A total of 1,029 inpatients at Wuhan Children's Hospital before the late puberty stage were enrolled in the study, including 815 children with obesity (non-NAFLD group) and 214 children with obesity and NAFLD (NAFLD group) diagnosed by liver ultrasound. Subgroup analyses were performed according to sex and puberty. The anthropometric indices and laboratory test data of these 1,029 children were sorted. After intergroup comparison, a logistic regression model was used to determine the risk factors for pediatric NAFLD. Significant risk factors for NAFLD were further tested using receiver operating characteristic (ROC) curves to evaluate their ability to predict an early diagnosis of NAFLD.
The NAFLD group had a mean age of 11.03 ± 1.66, with 11.18 ± 1.66 and 10.27 ± 1.45 years for male and female children, respectively ( < 0.05 and < 0.01, respectively). Even subdivided by both sex and puberty, raised body mass index (BMI), homeostatic model-insulin resistance, triglycerides, alanine transaminase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (γ-GT) were still found in the non-NAFLD and NAFLD groups ( < 0.05 and < 0.01, respectively). The results of logistic regression analysis showed that BMI (odds ratio [OR], 1.468;95% confidence interval [CI], 1.356-1.590; <0.001) and ALT (OR, 1.073;95%CI, 1.060-1.087; <0.001) were two most independent risk factors for NAFLD. The maximal OR for BMI was 1.721 (95% CI, 1.336-2.217). In the female group, the maximal OR of ALT was found to be 1.104 (95% CI, 1.061-1.148). Age and thyroid-stimulating hormone (TSH) and γ-GT levels were also risk factors, but they appeared only in some groups. The results of the ROC analysis showed that ALT was a better predictor of pediatric NAFLD than BMI. The maximum area under the ROC curve in six of the nine groups belongs to ALT.
BMI, ALT, and age are risk factors for NAFLD in children with obesity before late puberty. BMI had the greatest exposure risk for NAFLD, and ALT had the highest predictive value for the diagnosis of NAFLD. At the stratified level, for exposure risk, age was specific to the male sex, TSH was specific to the early puberty stage, and γ-GT was specific to the female sex plus the prepuberty stage. On a stratified level, for the female sex, even with age stratification, BMI rather than ALT has a better ability for the diagnosis of NAFLD.
本研究旨在确定中国中部肥胖儿童非酒精性脂肪性肝病（NAFLD）的临床特征，并验证一些已知的儿科 NAFLD 风险因素在青春期后期之前的适用性。
这是一项回顾性病例对照研究。共纳入武汉儿童医院青春期前的 1029 例住院患儿，包括 815 例肥胖患儿（非 NAFLD 组）和 214 例肥胖伴 NAFLD 患儿（NAFLD 组），由肝脏超声诊断。根据性别和青春期进行亚组分析。对这 1029 例患儿的人体测量学指标和实验室检查数据进行排序。在组间比较后，采用 logistic 回归模型确定儿科 NAFLD 的危险因素。使用受试者工作特征（ROC）曲线进一步检验有意义的 NAFLD 危险因素，以评估其对早期诊断 NAFLD 的能力。
NAFLD 组的平均年龄为 11.03±1.66 岁，男性和女性儿童的平均年龄分别为 11.18±1.66 岁和 10.27±1.45 岁（<0.05 和 <0.01）。即使按照性别和青春期进行细分，非 NAFLD 和 NAFLD 组仍存在升高的体重指数（BMI）、稳态模型胰岛素抵抗、甘油三酯、丙氨酸转氨酶（ALT）、天门冬氨酸转氨酶（AST）和γ-谷氨酰转移酶（γ-GT）（<0.05 和 <0.01）。logistic 回归分析结果显示，BMI（比值比[OR]，1.468；95%置信区间[CI]，1.356-1.590；<0.001）和 ALT（OR，1.073；95%CI，1.060-1.087；<0.001）是 NAFLD 的两个最独立的危险因素。BMI 的最大 OR 为 1.721（95%CI，1.336-2.217）。在女性组中，ALT 的最大 OR 为 1.104（95%CI，1.061-1.148）。年龄和促甲状腺激素（TSH）和 γ-GT 水平也是危险因素，但它们仅出现在某些组中。ROC 分析结果表明，ALT 是预测儿科 NAFLD 的较好指标，在 9 组中有 6 组的 ROC 曲线下面积最大的属于 ALT。
在青春期前肥胖儿童中，BMI、ALT 和年龄是非酒精性脂肪性肝病的危险因素。BMI 对 NAFLD 的暴露风险最大，ALT 对 NAFLD 的诊断预测价值最高。在分层水平上，对于暴露风险，年龄对男性具有特异性，TSH 对早期青春期具有特异性，γ-GT 对女性加青春期前具有特异性。在分层水平上，对于女性，即使进行年龄分层，BMI 而不是 ALT 对 NAFLD 的诊断能力更好。
