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Obez Çocuk ve Ergenlerde D Vitamini ve Tiroid Fonksiyonlarının Yağlı Karaciğer Hastalığı ile İlişkisinin Değerlendirilmesi

Year 2020, Volume: 18 Issue: 3, 421 - 433, 18.12.2020

Selma Tunç Meliha Demiral

Abstract

GİRİŞ ve AMAÇ: Çocuklarda ve ergenlerde Yağlı Karaciğer Hastalığı (YKH) prevelansı giderek artmaktadır. İlişkili risk faktörlerini tespit etmek, YKH’nın erken tanı ve tedavisinde önemlidir. Obez çocuk ve ergenlerde D vitamini ve tiroid fonksiyonları ile YKH arasındaki ilişkisinin araştırılması amaçlanmıştır.

YÖNTEM ve GEREÇLER: Çalışmaya 8-18 yaş arasında toplam 280 obez çocuk ve ergen dahil edildi. Karaciğerde yağlanma varlığı ultrasonografisi ile araştırıldı. Olgular 2 gruba ayrıldı. Yağlı karaciğer hastalığı olan ve olmayan gruplar, antropometrik parametreler (yaş, vücut kitle indeksi SDS, bel/kalça çevresi oranı) ve laboratuvar parametreleri [serum glukoz, AST, ALT, lipit profili, 25 OH vitamin D, serbest T4, serbest T3, TSH ve HOMA-IR) açısından karşılaştırıldı.

BULGULAR: Olguların %63,2'inde (n=177) YKH ve %49’ unda ALT yüksekliği saptandı. YKH olmayan grupla karşılaştırıldığında YKH olan grupta yaş, VKİ SDS, bel/kalça oranı, ALT, trigliserid, TSH düzeyi (p=0,01), HOMA-IR değerleri anlamlı olarak daha yüksek saptandı. 25 OH vitamin D düzeyi ise anlamlı olarak daha düşüktü (p=0,001). Bunun dışındaki parametreler (cinsiyet, glukoz, total kolesterol, HDL kolesterol, LDL kolesterol, AST, sT4 ve sT3) her iki grupta benzerdi.
Hepatosteatoz derecesi ile yaş, VKİ SDS, bel/kalça oranı, ALT, trigliserid ve HOMA-IR düzeyleri arasında pozitif korelasyon saptandı. D vitamini ile hepatosteatoz derecesi ve ALT düzeyi arasında ise negatif bir korelasyon vardı. TSH, sT4 ve sT3 düzeyleri ile hepatosteatoz derecesi arasında herhangi bir korelasyon saptanmadı.

TARTIŞMA ve SONUÇ: Obez çocuk ve ergenlerde yüksek TSH ve düşük D vitamini düzeyi YKH ile ilişkilidir. Obezite derecesi ve yaş arttıkça YKH görülme riski de artar. Bunlara ek olarak artmış ALT, trigliserid, HOMA-IR YKH gelişimindeki risk faktörleridir. Bu bulgular, klinisyenlere karaciğer biyopsisi ve / veya daha agresif tedavi edici müdahalelere ihtiyaç duyan çocukları tespit etmeye yardımcı olmak için noninvaziv bir tarama aracı olarak kullanılabilir.

Keywords

çocuklar yağlı karaciğer d vitamini

References

  • 1. Tiniakos DG, Vos MB, Brunt EM. Nonalcoholic fatty liver disease: pathology and pathogenesis. Annu Rev Pathol 2010;5:145–71.

  • 2. Tominaga K, Kurata JH, Chen YK, Fujimoto E, Miyagawa S, Abe I, et al. Prevalence of fatty liver in Japanese children and relation to obesity: an epidemiological ultrasonographic survey. Dig Dis Sci 1995;40:2002-9.
  • 3. Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of fatty liver in children and adolescents. Pediatrics 2006;118:1388–93.

  • 4. Vajro P, Lenta S, Socha P, Dhawan A, MkKiernan P, Baumann U, et al. Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr 2012;54:700–13.
  • 5. Bacon BR, Farahvash MJ, Janney CG, Neuschwander-Tetri BA. Nonalcoholic steatohepatitis: an expanded clinical entity. Gastroenterology 1994;107:1103-9.
  • 6. Nobili V, Reale A, Alısi A, Morino G, Trenta I, Pisani M et al. Elevated serum ALT in children presenting to the emergency unit: relationship with NAFLD. Dig Liver Dis 2009;41:749–52.
  • 7. Schwimmer JB, Newton KP, Awai HI, Choi LJ, Garcia MA, Ellis LL et al. Paediatric gastroenterology evaluation of overweight and obese children referred from primary care for suspected non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2013;38:1267–77.
  • 8. Eminoğlu TF,, Camurdan OM, Oktar SO, Bideci A, Dalgiç B. Factors related to non-alcoholic fatty liver disease in obese children. Turk J Gastroenterol. 2008;19(2):85-91.
  • 9. Troung-Minh Pham, John Paul Ekwaru, Solmaz setayeshgar, Paul J Veugelers. The Effect of Changing on Metabolic Syndrome: A Longitudinal Analysis of Participants of a Preventive Health Program. Nutrients. 201;7(9):7271-84.
  • 10. Black LJ, Jacoby P, She Ping-Delfos WC, Mori TA, Beilin LJ, Olynyk JK, et al. Low serum 25-hy- droxyvitamin D concentrations associate with non-alcoholic fatty liver disease in adolescents independent of adiposity. J Gastroenterol Hepatol 2014;29:1215-22.
  • 11. Roth CL, Elfers CT, Figlewicz DP. Vitamin D deficiency in obese rats exacerbates nonalcoholic fatty liver disease and increases hepatic resistin and Toll-like receptor activation. Hepatology 2012;55:1103–11.
  • 12. Hourigan SK1, Abrams S, Yates K, Pfeifer K, Torbenson M, Murray K et al. NASH CRN. Relation between vitamin D status and nonalcoholic fatty liver disease in children. J Pediatr Gastroenterol Nutr. 2015;60(3):396-404.
  • 13. Sezer OB, Buluş D, Hızlı Ş, Andıran N, Yılmaz D, Ramadan SU. Low 25-hydroxyvitamin D level is not an independent risk factor for hepatosteatosis in obese children. Pediatr Endocrinol Metab. 2016;29(7):783-8.
  • 14. Yildiz I, Erol OB, Toprak S, Cantez MS, Omer B. Role of vitamin D in children with hepatosteatosis. J Pediatr Gastroenterol Nutr 2014;59:106–11.
  • 15. Pirgon O, Cekmez F, Bilgin H, Eren E, Dundar B. Low 25-hydroxy-vitamin D level is associated with insulin sensitivity in obese adolescents with non-alcoholic fatty liver disease. Obes Res Clin Pract 2013;7:275–83.
  • 16. Gökmen FY, Ahbab S, Ataoğlu HE, Türker BÇ, Çetin F, Türker F, et al. FT3/FT4 ratio predicts non-alcoholic fatty liver disease independent of metabolic parameters in patients with euthyroidism and hypothyroidism. Pediatr Obes. 2017;12(1):67-74.
  • 17. Bilgin H, Pirgon Ö. Thyroid function in obese children with non-alcoholic fatty liver disease. J Clin Res Pediatr Endocrinol. 2014;6(3):152-7.
  • 18. Denzer C, Karges B, Nake A, Rosenbauer J, Schober E, Schwab KO et al. Subclinical hypothyroidism and dyslipidemia in children and adolescents with type 1 diabetes mellitus. Eur J Endocrinol 2013;168:601–8.
  • 19. Brufani C, Manco M, Nobili V, Fintini D, Barbetti F, Cappa M. Thyroid function tests in obese prepubertal children: correlations with insulin sensitivity and body fat distribution. Horm Res Paediatr 2012;78:100–5.
  • 20. Liangpunsakul S, Chalasani N. Is hypothyroidism a risk factor for non-alcoholic steatohepatitis? J Clin Gastroenterol 2003;37:340–3.

  • 21. Kaltenbach TE, Graeter T, Oeztuerk S, Holzner D, Kratzer W, Wabitsch M, et al. Thyroid dysfunction and hepatic steatosis in overweight children and adolescents. Pediatr Obes. 2017;12(1):67-74.
  • 22. Chung GE, Kim D, Kim W, Yim JY, Park MJ, Kim YJ, et al. Non-alcoholic fatty liver disease across the spectrum of hypothyroidism. J Hepatol 2012;57:150–6.
  • 23. Pacifico L, Bonci E, Ferraro F, Andreoli G, Bascetta S, Chiesa C. Hepatic steatosis and thyroid function tests in overweight and obese children. Int J Endocrinol 2013;381014.
  • 24. Torun E, Ozgen IT, Gokce S, Aydin S, Cesur Y. Thyroid hormone levels in obese children and adolescents with non-alcoholic fatty liver disease. J Clin Res Pediatr Endocrinol 2014;6:34–9.
  • 25. Neyzi O, Furman A, Bundak R, Gunoz H, Darendeliler F, Bas F. Growth references for Turkish children aged 6 to 18 years. Acta Paediatr. 2006;95(12):1635-41.
  • 26. Bordini B, Rosenfield RL. Normal pubertal development: part II: clinical aspects of puberty. Pediatr Rev. 2011;32(7):281-92.
  • 27. Schwimmer JB, DunnW, Norman GJ, Pardee PE, Middleton MS, Kerkan N, et al. SAFETY study: alanine aminotransferase cutoff values are set too high for reliable detection of pediatric chronic liver disease. Gastroenterology. 2010;138(4):1357.
  • 28. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics. 2005;115(4), 500-3.
  • 29. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents an IDF consensus report. IDF Consensus Group. Pediatr Diabetes. 2007;8(5):299-306.
  • 30. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012;22(12):1200-35.

  • 31. US Department of Health and Human Services. Vitamin D status: United States, 2001-2006. HCHS Data Brief, 59:2011;1-8.
  • 32. Jimenez-Rivera C, Hadjiyannakis S, Davila J, Hurteau J, Aglipay M, Barrowman N, et al. Prevalence and risk factors for non-alcoholic fatty liver in children and youth with obesity. BMC Pediatr. 2017;17(1):113.
  • 33. Geier A. Shedding new light on vitamin D and fatty liver disease. J Hepatol 2011;55:273–5 

  • 34. Chang EJ, Yi DY, Yang HR. Vitamin D Status and Bone Mineral Density in Obese Children with Nonalcoholic Fatty Liver Disease. J Korean Med Sci 2015;30(12):1821-7.
  • 35. Yildiz I, Erol OB, Toprak S, Cantez MS, Omer B, Kilic A, et al. Role of vitamin D in children with hepatosteatosis. J Pediatr Gastroenterol Nutr. 2014;59(1):106-11
  • 36. Cappola AR, Ladenson PW. Hypothyroidism and atherosclerosis. J Clin Endocrinol Metab 2003;88:2438–44.

  • 37. Rodondi N, den Elzen WP, Bauer DC, et al. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA 2010;304:1365–74.

  • 38. Hernaez R, Lazo M, Bonekamp S, et al. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology 2011;54:1082–90.
  • 39. Shannon A, Alkhouri N, Carter-Kent C, et al. Ultrasonographic quantitative estimation of hepatic steatosis in children With NAFLD. J Pediatr Gastroenterol Nutr 2011;53:190–5.

Year 2020, Volume: 18 Issue: 3, 421 - 433, 18.12.2020

Selma Tunç Meliha Demiral

Abstract

References

  • 1. Tiniakos DG, Vos MB, Brunt EM. Nonalcoholic fatty liver disease: pathology and pathogenesis. Annu Rev Pathol 2010;5:145–71.

  • 2. Tominaga K, Kurata JH, Chen YK, Fujimoto E, Miyagawa S, Abe I, et al. Prevalence of fatty liver in Japanese children and relation to obesity: an epidemiological ultrasonographic survey. Dig Dis Sci 1995;40:2002-9.
  • 3. Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of fatty liver in children and adolescents. Pediatrics 2006;118:1388–93.

  • 4. Vajro P, Lenta S, Socha P, Dhawan A, MkKiernan P, Baumann U, et al. Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr 2012;54:700–13.
  • 5. Bacon BR, Farahvash MJ, Janney CG, Neuschwander-Tetri BA. Nonalcoholic steatohepatitis: an expanded clinical entity. Gastroenterology 1994;107:1103-9.
  • 6. Nobili V, Reale A, Alısi A, Morino G, Trenta I, Pisani M et al. Elevated serum ALT in children presenting to the emergency unit: relationship with NAFLD. Dig Liver Dis 2009;41:749–52.
  • 7. Schwimmer JB, Newton KP, Awai HI, Choi LJ, Garcia MA, Ellis LL et al. Paediatric gastroenterology evaluation of overweight and obese children referred from primary care for suspected non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2013;38:1267–77.
  • 8. Eminoğlu TF,, Camurdan OM, Oktar SO, Bideci A, Dalgiç B. Factors related to non-alcoholic fatty liver disease in obese children. Turk J Gastroenterol. 2008;19(2):85-91.
  • 9. Troung-Minh Pham, John Paul Ekwaru, Solmaz setayeshgar, Paul J Veugelers. The Effect of Changing on Metabolic Syndrome: A Longitudinal Analysis of Participants of a Preventive Health Program. Nutrients. 201;7(9):7271-84.
  • 10. Black LJ, Jacoby P, She Ping-Delfos WC, Mori TA, Beilin LJ, Olynyk JK, et al. Low serum 25-hy- droxyvitamin D concentrations associate with non-alcoholic fatty liver disease in adolescents independent of adiposity. J Gastroenterol Hepatol 2014;29:1215-22.
  • 11. Roth CL, Elfers CT, Figlewicz DP. Vitamin D deficiency in obese rats exacerbates nonalcoholic fatty liver disease and increases hepatic resistin and Toll-like receptor activation. Hepatology 2012;55:1103–11.
  • 12. Hourigan SK1, Abrams S, Yates K, Pfeifer K, Torbenson M, Murray K et al. NASH CRN. Relation between vitamin D status and nonalcoholic fatty liver disease in children. J Pediatr Gastroenterol Nutr. 2015;60(3):396-404.
  • 13. Sezer OB, Buluş D, Hızlı Ş, Andıran N, Yılmaz D, Ramadan SU. Low 25-hydroxyvitamin D level is not an independent risk factor for hepatosteatosis in obese children. Pediatr Endocrinol Metab. 2016;29(7):783-8.
  • 14. Yildiz I, Erol OB, Toprak S, Cantez MS, Omer B. Role of vitamin D in children with hepatosteatosis. J Pediatr Gastroenterol Nutr 2014;59:106–11.
  • 15. Pirgon O, Cekmez F, Bilgin H, Eren E, Dundar B. Low 25-hydroxy-vitamin D level is associated with insulin sensitivity in obese adolescents with non-alcoholic fatty liver disease. Obes Res Clin Pract 2013;7:275–83.
  • 16. Gökmen FY, Ahbab S, Ataoğlu HE, Türker BÇ, Çetin F, Türker F, et al. FT3/FT4 ratio predicts non-alcoholic fatty liver disease independent of metabolic parameters in patients with euthyroidism and hypothyroidism. Pediatr Obes. 2017;12(1):67-74.
  • 17. Bilgin H, Pirgon Ö. Thyroid function in obese children with non-alcoholic fatty liver disease. J Clin Res Pediatr Endocrinol. 2014;6(3):152-7.
  • 18. Denzer C, Karges B, Nake A, Rosenbauer J, Schober E, Schwab KO et al. Subclinical hypothyroidism and dyslipidemia in children and adolescents with type 1 diabetes mellitus. Eur J Endocrinol 2013;168:601–8.
  • 19. Brufani C, Manco M, Nobili V, Fintini D, Barbetti F, Cappa M. Thyroid function tests in obese prepubertal children: correlations with insulin sensitivity and body fat distribution. Horm Res Paediatr 2012;78:100–5.
  • 20. Liangpunsakul S, Chalasani N. Is hypothyroidism a risk factor for non-alcoholic steatohepatitis? J Clin Gastroenterol 2003;37:340–3.

  • 21. Kaltenbach TE, Graeter T, Oeztuerk S, Holzner D, Kratzer W, Wabitsch M, et al. Thyroid dysfunction and hepatic steatosis in overweight children and adolescents. Pediatr Obes. 2017;12(1):67-74.
  • 22. Chung GE, Kim D, Kim W, Yim JY, Park MJ, Kim YJ, et al. Non-alcoholic fatty liver disease across the spectrum of hypothyroidism. J Hepatol 2012;57:150–6.
  • 23. Pacifico L, Bonci E, Ferraro F, Andreoli G, Bascetta S, Chiesa C. Hepatic steatosis and thyroid function tests in overweight and obese children. Int J Endocrinol 2013;381014.
  • 24. Torun E, Ozgen IT, Gokce S, Aydin S, Cesur Y. Thyroid hormone levels in obese children and adolescents with non-alcoholic fatty liver disease. J Clin Res Pediatr Endocrinol 2014;6:34–9.
  • 25. Neyzi O, Furman A, Bundak R, Gunoz H, Darendeliler F, Bas F. Growth references for Turkish children aged 6 to 18 years. Acta Paediatr. 2006;95(12):1635-41.
  • 26. Bordini B, Rosenfield RL. Normal pubertal development: part II: clinical aspects of puberty. Pediatr Rev. 2011;32(7):281-92.
  • 27. Schwimmer JB, DunnW, Norman GJ, Pardee PE, Middleton MS, Kerkan N, et al. SAFETY study: alanine aminotransferase cutoff values are set too high for reliable detection of pediatric chronic liver disease. Gastroenterology. 2010;138(4):1357.
  • 28. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics. 2005;115(4), 500-3.
  • 29. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents an IDF consensus report. IDF Consensus Group. Pediatr Diabetes. 2007;8(5):299-306.
  • 30. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012;22(12):1200-35.

  • 31. US Department of Health and Human Services. Vitamin D status: United States, 2001-2006. HCHS Data Brief, 59:2011;1-8.
  • 32. Jimenez-Rivera C, Hadjiyannakis S, Davila J, Hurteau J, Aglipay M, Barrowman N, et al. Prevalence and risk factors for non-alcoholic fatty liver in children and youth with obesity. BMC Pediatr. 2017;17(1):113.
  • 33. Geier A. Shedding new light on vitamin D and fatty liver disease. J Hepatol 2011;55:273–5 

  • 34. Chang EJ, Yi DY, Yang HR. Vitamin D Status and Bone Mineral Density in Obese Children with Nonalcoholic Fatty Liver Disease. J Korean Med Sci 2015;30(12):1821-7.
  • 35. Yildiz I, Erol OB, Toprak S, Cantez MS, Omer B, Kilic A, et al. Role of vitamin D in children with hepatosteatosis. J Pediatr Gastroenterol Nutr. 2014;59(1):106-11
  • 36. Cappola AR, Ladenson PW. Hypothyroidism and atherosclerosis. J Clin Endocrinol Metab 2003;88:2438–44.

  • 37. Rodondi N, den Elzen WP, Bauer DC, et al. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA 2010;304:1365–74.

  • 38. Hernaez R, Lazo M, Bonekamp S, et al. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology 2011;54:1082–90.
  • 39. Shannon A, Alkhouri N, Carter-Kent C, et al. Ultrasonographic quantitative estimation of hepatic steatosis in children With NAFLD. J Pediatr Gastroenterol Nutr 2011;53:190–5.
There are 39 citations in total.

Details

Primary Language Turkish
Subjects ​Internal Diseases
Journal Section Research Article
Authors

Selma Tunç

Meliha Demiral

Publication Date December 18, 2020
Published in Issue Year 2020 Volume: 18 Issue: 3

Cite

APA Tunç, S., & Demiral, M. (n.d.). Obez Çocuk ve Ergenlerde D Vitamini ve Tiroid Fonksiyonlarının Yağlı Karaciğer Hastalığı ile İlişkisinin Değerlendirilmesi. Güncel Pediatri, 18(3), 421-433. https://doi.org/10.32941/pediatri.841463
AMA Tunç S, Demiral M. Obez Çocuk ve Ergenlerde D Vitamini ve Tiroid Fonksiyonlarının Yağlı Karaciğer Hastalığı ile İlişkisinin Değerlendirilmesi. Güncel Pediatri. 18(3):421-433. doi:10.32941/pediatri.841463
Chicago Tunç, Selma, and Meliha Demiral. “Obez Çocuk Ve Ergenlerde D Vitamini Ve Tiroid Fonksiyonlarının Yağlı Karaciğer Hastalığı Ile İlişkisinin Değerlendirilmesi”. Güncel Pediatri 18, no. 3 n.d.: 421-33. https://doi.org/10.32941/pediatri.841463.
EndNote Tunç S, Demiral M Obez Çocuk ve Ergenlerde D Vitamini ve Tiroid Fonksiyonlarının Yağlı Karaciğer Hastalığı ile İlişkisinin Değerlendirilmesi. Güncel Pediatri 18 3 421–433.
IEEE S. Tunç and M. Demiral, “Obez Çocuk ve Ergenlerde D Vitamini ve Tiroid Fonksiyonlarının Yağlı Karaciğer Hastalığı ile İlişkisinin Değerlendirilmesi”, Güncel Pediatri, vol. 18, no. 3, pp. 421–433, doi: 10.32941/pediatri.841463.
ISNAD Tunç, Selma - Demiral, Meliha. “Obez Çocuk Ve Ergenlerde D Vitamini Ve Tiroid Fonksiyonlarının Yağlı Karaciğer Hastalığı Ile İlişkisinin Değerlendirilmesi”. Güncel Pediatri 18/3 (n.d.), 421-433. https://doi.org/10.32941/pediatri.841463.
JAMA Tunç S, Demiral M. Obez Çocuk ve Ergenlerde D Vitamini ve Tiroid Fonksiyonlarının Yağlı Karaciğer Hastalığı ile İlişkisinin Değerlendirilmesi. Güncel Pediatri.;18:421–433.
MLA Tunç, Selma and Meliha Demiral. “Obez Çocuk Ve Ergenlerde D Vitamini Ve Tiroid Fonksiyonlarının Yağlı Karaciğer Hastalığı Ile İlişkisinin Değerlendirilmesi”. Güncel Pediatri, vol. 18, no. 3, pp. 421-33, doi:10.32941/pediatri.841463.
Vancouver Tunç S, Demiral M. Obez Çocuk ve Ergenlerde D Vitamini ve Tiroid Fonksiyonlarının Yağlı Karaciğer Hastalığı ile İlişkisinin Değerlendirilmesi. Güncel Pediatri. 18(3):421-33.