Speakman Alexandria, Hitchcock Kathryn, Romantic Emily, Quiambao Venancio, Lepolt Abigail, Ley Sanita, Arce-Clachar Ana Catalina, Bramlage Kristin, Fei Lin, Sun Qin, Xanthakos Stavra, Mouzaki Marialena
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH.
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
J Pediatr. 2025 Jan;276:114301. doi: 10.1016/j.jpeds.2024.114301. Epub 2024 Sep 13.
To investigate the relationship between longitudinal changes in body composition and liver disease severity in children with metabolic dysfunction-associated steatotic liver disease (MASLD).
This longitudinal, single-center, retrospective analysis included patients aged <20 years followed for MASLD who had had ≥2 bioelectrical impedance analyses (BIAs) performed. MASLD regression was defined as alanine aminotransferase (ALT) normalization or a decrease of >50% from baseline. Fat and skeletal muscle mass were adjusted for size by calculating respective indices (dividing by height). Logistic and linear regressions were used to determine the independent relationship between changes in body composition over time and serological markers of liver disease severity.
We included 258 patients (75% male, 50% Hispanic) with a median age of 14 years (IQR, 11-16 years) at the time of first BIA. Median body mass index (BMI) z-score at baseline was 2.33 (IQR, 2.04-2.62). Median time from first to last BIA was 12 months (IQR, 6-24 months). A decrease in fat mass index was independently associated with reductions in ALT and gamma glutamyl transferase and increased odds of MASLD regression (OR; 0.55; P < .001). Fat mass index reduction was superior to BMI z-score in predicting MASLD regression. Change in skeletal muscle mass index was not associated with change in ALT or gamma glutamyl transferase.
Changes in fat mass, not skeletal muscle mass, are associated with serological markers of liver injury in youth with MASLD. Fat mass changes outperform BMI z-score changes in predicting MASLD regression. BIA can serve as an adjunct biomarker of liver disease progression.
探讨代谢功能障碍相关脂肪性肝病（MASLD）患儿身体成分的纵向变化与肝病严重程度之间的关系。
这项纵向、单中心回顾性分析纳入了年龄小于20岁、因MASLD接受随访且进行了≥2次生物电阻抗分析（BIA）的患者。MASLD缓解定义为丙氨酸氨基转移酶（ALT）恢复正常或较基线水平降低>50%。通过计算各自的指数（除以身高）对脂肪和骨骼肌质量进行大小调整。采用逻辑回归和线性回归来确定身体成分随时间的变化与肝病严重程度的血清学标志物之间的独立关系。
我们纳入了258例患者（75%为男性，50%为西班牙裔），首次BIA时的中位年龄为14岁（四分位间距，11 - 16岁）。基线时的中位体重指数（BMI）z评分是2.33（四分位间距，2.04 - 2.62）。从首次到末次BIA的中位时间为12个月（四分位间距，6 - 24个月）。脂肪质量指数降低与ALT和γ-谷氨酰转移酶降低以及MASLD缓解几率增加独立相关（比值比；0.55；P <.001）。在预测MASLD缓解方面，脂肪质量指数降低优于BMI z评分。骨骼肌质量指数的变化与ALT或γ-谷氨酰转移酶的变化无关。
在患有MASLD的青少年中，脂肪质量的变化而非骨骼肌质量的变化与肝损伤的血清学标志物相关。在预测MASLD缓解方面，脂肪质量变化优于BMI z评分变化。BIA可作为肝病进展的辅助生物标志物。
