de Boom Fien, Talib Ali, Roebroek Yvonne G M, Paulus Givan F, Koek Ger H, Robben Simon G F, Winkens Bjorn, Bouvy Nicole D, van Heurn L W Ernest
Department of Surgery, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands.
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, 6211 LK Maastricht, The Netherlands.
Children (Basel). 2024 Aug 11;11(8):965. doi: 10.3390/children11080965.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease in adolescents with obesity. Nonetheless, the guidelines for screening and managing this disease are contradictory. The purpose of this study is to non-invasively assess the prevalence, patient characteristics, and potential associated factors of MASLD in this demographic. This study used baseline data from an RCT in adolescents eligible for bariatric surgery. MASLD was determined by measuring the hepatorenal index (HRI) with ultrasonography, blood liver tests, and the fatty liver index (FLI). A total of 56 adolescents enrolled in the analyses; the majority were female = 44 (79%); the mean age was 15.75 (±1.01) years; the average body mass index (BMI) was 44.08 (±5.16) kg/m. In 35 (62.5%) of the patients, the HRI was abnormal. This group had a higher waist/hip ratio, elevated liver biochemistry, and significantly lower leptin levels (mean difference = -46.35, 95% CI -76.72, -15.99) compared to the group with a normal HRI. In 32 (55.2%) of the patients, ALT levels were elevated and the FLI was abnormal in all (100%) participants. Linear regression analysis indicated associations between the HRI and typical anthropometric and metabolic measurements; and an inverse association between HRI and leptin B = -0.003 (95% CI -0.005, -0.00), independently of sex- and age-adjusted BMI. MASLD is highly prevalent in adolescents with severe obesity. However, the prevalence strongly depends on which tool is used, namely the HRI (62.5%), alanine transaminase levels (55.2%), and FLI (100%). Our findings suggest that leptin may be a valuable biomarker in supporting the diagnosis of MASLD.
代谢功能障碍相关脂肪性肝病（MASLD）是肥胖青少年中最常见的肝脏疾病。尽管如此，针对该疾病的筛查和管理指南却相互矛盾。本研究的目的是对这一人群中MASLD的患病率、患者特征及潜在相关因素进行非侵入性评估。本研究使用了一项针对符合减重手术条件的青少年的随机对照试验的基线数据。通过超声测量肝肾指数（HRI）、血液肝脏检查和脂肪肝指数（FLI）来确定MASLD。共有56名青少年纳入分析；大多数为女性，共44名（79%）；平均年龄为15.75（±1.01）岁；平均体重指数（BMI）为44.08（±5.16）kg/m²。35名（62.5%）患者的HRI异常。与HRI正常的组相比，该组的腰臀比更高、肝脏生化指标升高且瘦素水平显著更低（平均差值 = -46.35，95%可信区间 -76.72，-15.99）。32名（55.2%）患者的谷丙转氨酶（ALT）水平升高，且所有参与者（100%）的FLI均异常。线性回归分析表明HRI与典型人体测量和代谢指标之间存在关联；且独立于性别和年龄调整后的BMI，HRI与瘦素之间存在负相关，B = -0.003（95%可信区间 -0.005，-0.00）。MASLD在重度肥胖青少年中非常普遍。然而，患病率很大程度上取决于所使用的工具，即HRI（62.5%）、丙氨酸转氨酶水平（55.2%）和FLI（100%）。我们的研究结果表明，瘦素可能是支持MASLD诊断的一种有价值的生物标志物。
