Özer Yavuz, Ulu Ersin, Yurdakul Ertürk Emine
Department of Pediatric Endocrinology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey.
Cerrahpasa Medical Faculty, Department of Neonatology, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Pediatr Int. 2025 Jan-Dec;67(1):e70205. doi: 10.1111/ped.70205.
This study aimed to evaluate the effectiveness of the tri-ponderal mass index (TMI) in identifying metabolic dysfunction-associated fatty liver disease (MAFLD) in obese children and adolescents.
A total of 238 obese children and adolescents were included in the study. Evaluations included anthropometric measurements, liver function tests, lipid parameters, fasting glucose, insulin, and HOMA-IR. Logistic regression analysis was performed to determine the predictive value of TMI for MAFLD.
MAFLD was diagnosed in 55.5% of participants. TMI values were significantly higher in the MAFLD group compared to those without MAFLD (mean TMI: 21.01 ± 3.05 vs. 20.14 ± 2.90, p = 0.026). In logistic regression analyses, male sex was an independent predictor in both models (OR = 3.10, p = 0.003 in the BMI-SDS model; OR = 2.63, p = 0.008 in the TMI model). HOMA-IR (OR = 1.10, p = 0.042; OR = 1.11, p = 0.029) and ALT (OR = 1.04, p = 0.002; OR = 1.05, p = 0.002) were also significant in both models. TMI was not independently associated with MAFLD (p = 0.249). TMI showed positive correlations with age, weight-SDS, BMI-SDS, fasting insulin, HbA1c, HOMA-IR, and the grade of hepatosteatosis.
While TMI values were higher in patients with MAFLD, TMI was not an independent predictor of MAFLD in obese children. Male sex, HOMA-IR, and ALT were consistently associated with MAFLD, suggesting greater predictive value. These findings suggest that TMI may have limited utility as a screening tool for MAFLD in pediatric clinical practice.
本研究旨在评估三 ponderal 质量指数（TMI）在识别肥胖儿童和青少年代谢功能障碍相关脂肪性肝病（MAFLD）中的有效性。
共有238名肥胖儿童和青少年纳入本研究。评估包括人体测量、肝功能检查、血脂参数、空腹血糖、胰岛素和HOMA-IR。进行逻辑回归分析以确定TMI对MAFLD的预测价值。
55.5%的参与者被诊断为MAFLD。与无MAFLD者相比，MAFLD组的TMI值显著更高（平均TMI：21.01±3.05 vs. 20.14±2.90，p = 0.026）。在逻辑回归分析中，男性在两个模型中均为独立预测因素（BMI-SDS模型中OR = 3.10，p = 0.003；TMI模型中OR = 2.63，p = 0.008）。HOMA-IR（OR = 1.10，p = 0.042；OR = 1.11，p = 0.029）和ALT（OR = 1.04，p = 0.002；OR = 1.05，p = 0.002）在两个模型中也均有显著意义。TMI与MAFLD无独立相关性（p = 0.249）。TMI与年龄、体重-SDS、BMI-SDS、空腹胰岛素、糖化血红蛋白、HOMA-IR和肝脂肪变性分级呈正相关。
虽然MAFLD患者的TMI值较高，但TMI并非肥胖儿童MAFLD的独立预测因素。男性、HOMA-IR和ALT始终与MAFLD相关，提示具有更大的预测价值。这些发现表明，在儿科临床实践中，TMI作为MAFLD的筛查工具可能效用有限。
