Calcaterra Valeria, Degrassi Irene, Taranto Silvia, Porro Cecilia, Bianchi Alice, L'assainato Sara, Silvestro Giustino Simone, Quatrale Antonia, Zuccotti Gianvincenzo
Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy.
Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy.
Children (Basel). 2024 Feb 15;11(2):244. doi: 10.3390/children11020244.
Metabolic dysfunction-associated fatty liver disease (MAFLD) is a multisystem disorder characterized by the presence of fatty liver degeneration associated with excess adiposity or prediabetes/type 2 diabetes or metabolic dysregulation. An intricate relationship between the liver and thyroid has been reported in both health and disease. Simultaneously, there is a strong correlation between obesity and both MAFLD and thyroid dysfunction. In this narrative review, we highlighted the relationship between MAFLD and thyroid function in children and adolescents with obesity in order to explore how thyroid hormones (THs) act as predisposing factors in the onset, progression, and sustainability of MAFLD. THs are integral to the intricate balance of metabolic activities, ensuring energy homeostasis, and are indispensable for growth and development. Regarding liver homeostasis, THs have been suggested to interact with liver lipid homeostasis through a series of processes, including stimulating the entry of free fatty acids into the liver for esterification into triglycerides and increasing mitochondrial β-oxidation of fatty acids to impact hepatic lipid accumulation. The literature supports a correlation between MAFLD and obesity, THs and obesity, and MAFLD and THs; however, results in the pediatric population are very limited. Even though the underlying pathogenic mechanism involved in the relationship between MAFLD and thyroid function remains not fully elucidated, the role of THs as predisposing factors of MAFLD could be postulated. A potential vicious circle among these three conditions cannot be excluded. Identifying novel elements that may contribute to MAFLD could offer a practical approach to assessing children at risk of developing the condition.
代谢功能障碍相关脂肪性肝病（MAFLD）是一种多系统疾病，其特征是存在与肥胖、前驱糖尿病/2型糖尿病或代谢失调相关的脂肪肝变性。肝脏与甲状腺之间在健康和疾病状态下均存在复杂的关系。同时，肥胖与MAFLD及甲状腺功能障碍之间存在密切关联。在这篇叙述性综述中，我们着重探讨了肥胖儿童和青少年中MAFLD与甲状腺功能之间的关系，以探究甲状腺激素（THs）如何在MAFLD的发生、发展和持续过程中作为易感因素发挥作用。THs对于代谢活动的复杂平衡至关重要，可确保能量稳态，并且对生长发育不可或缺。关于肝脏稳态，有研究表明THs可通过一系列过程与肝脏脂质稳态相互作用，包括刺激游离脂肪酸进入肝脏以酯化为甘油三酯，以及增加脂肪酸的线粒体β氧化，从而影响肝脏脂质蓄积。文献支持MAFLD与肥胖、THs与肥胖以及MAFLD与THs之间存在相关性；然而，儿科人群中的研究结果非常有限。尽管MAFLD与甲状腺功能之间关系的潜在致病机制仍未完全阐明，但可以推测THs作为MAFLD易感因素的作用。不能排除这三种情况之间存在潜在恶性循环的可能性。确定可能导致MAFLD的新因素可为评估有患该病风险的儿童提供一种实用方法。
