Agir Mehmet Akif, Ozturk Mehmet, Korez Muslu Kazım, Gumus Meltem, Abidin Ilhan, Aydin Vesile Betül, Alp Esma Keles, Emiroglu Halil Haldun
Division of Pediatric Gastroenterology, Department of Pediatrics, Faculty of Medicine, Selcuk University, Konya, Turkey.
Department of Pediatric Radiology, Faculty of Medicine, Selcuk University, Konya, Turkey.
Eur J Pediatr. 2025 Sep 16;184(10):619. doi: 10.1007/s00431-025-06470-5.
This study aimed to assess the impact of malnutrition on liver and spleen stiffness in children using shear wave elastography (SWE) and to compare the findings with those of healthy controls.
A total of 308 children aged 0-18 years were prospectively enrolled and classified as either malnourished or healthy according to World Health Organization (WHO) growth reference standards (weight-for-height Z-scores for children under 5 years and BMI-for-age Z-scores for those aged 5 years and older). Liver and spleen stiffness measurements were obtained using SWE by a single pediatric radiologist blinded to nutritional status. Statistical comparisons were performed between groups, across malnutrition severity subgroups, and within different age categories.
Liver stiffness did not differ significantly between malnourished children overall and healthy controls, but it was markedly higher in those with severe malnutrition compared to mild or moderate cases (p = 0.018). Spleen stiffness was significantly lower in malnourished children aged 0-6 years compared to controls (p < 0.001). Both liver and spleen stiffness values increased with age (p = 0.014 and p = 0.013, respectively).
Our findings indicate that malnutrition is associated with age- and severity-dependent alterations in liver and spleen stiffness. Liver stiffness was elevated only in children with severe malnutrition, whereas spleen stiffness was reduced in younger children but not in older ones. SWE may serve as a valuable non-invasive tool for assessing organ-level effects of malnutrition, and these results may guide future research on the reversibility and clinical significance of such changes.
• Childhood malnutrition is associated with profound metabolic and structural alterations in vital organs such as the liver and spleen. However, its impact on organ biomechanics, as assessed by elastography, has not been clearly defined.
• Malnutrition leads to organ-specific biomechanical changes, with increased liver stiffness in severe cases and reduced spleen stiffness particularly in younger children. • Shear wave elastography provides a non-invasive approach to characterize these alterations.
本研究旨在利用剪切波弹性成像（SWE）评估营养不良对儿童肝脏和脾脏硬度的影响，并将结果与健康对照进行比较。
前瞻性纳入308名0至18岁儿童，根据世界卫生组织（WHO）生长参考标准（5岁以下儿童身高别体重Z评分，5岁及以上儿童年龄别BMI Z评分）分为营养不良组或健康组。由一名对营养状况不知情的儿科放射科医生使用SWE测量肝脏和脾脏硬度。在组间、不同营养不良严重程度亚组以及不同年龄类别内进行统计学比较。
总体而言，营养不良儿童与健康对照的肝脏硬度无显著差异，但重度营养不良儿童的肝脏硬度明显高于轻度或中度营养不良儿童（p = 0.018）。0至6岁营养不良儿童的脾脏硬度明显低于对照组（p < 0.001）。肝脏和脾脏硬度值均随年龄增加而升高（分别为p = 0.014和p = 0.013）。
我们的研究结果表明，营养不良与肝脏和脾脏硬度的年龄及严重程度依赖性改变有关。仅重度营养不良儿童的肝脏硬度升高，而脾脏硬度在年幼儿童中降低，年长儿童则不然。SWE可作为评估营养不良器官水平影响的有价值的非侵入性工具，这些结果可能为今后关于此类变化的可逆性和临床意义的研究提供指导。
• 儿童营养不良与肝脏和脾脏等重要器官深刻的代谢和结构改变有关。然而，通过弹性成像评估其对器官生物力学的影响尚未明确界定。
• 营养不良导致器官特异性生物力学变化，重度病例肝脏硬度增加，脾脏硬度降低，尤其是年幼儿童。• 剪切波弹性成像提供了一种表征这些改变的非侵入性方法。
