Obese Boys Wıth Low Concentratıons of Hıgh Densıty Lıpoproteın Cholesterol are at Greater Rısk of Hepatosteatosıs

Yıl 2019, Cilt: 7 Sayı: Ek - IRUPEC 2019 Kongresi Tam Metin Bildirileri, 404 - 409, 10.12.2019

Elif Özsu

Öz

Purpose: Non-alcoholic fatty liver disease (NAFLD) and associated morbidities have become a public health problem due to a global three-fold increase in incidence among obese children over the last three decades. Although the gold standard for diagnosis of NAFLD is liver biopsy, it is not widely used in children. Imaging techniques, including magnetic resonance and ultrasound, can provide information on liver fat deposition, with variable sensitivity. Therefore, a number of other predictors are being investigated for pediatric screening and diagnostic purposes. The aim of this study was to assess easily measured parameters to prompt further investigation for NAFLD in obese children. Methods: Obese children/adolescents with a Body Mass Index (BMI) percentile >95 were enrolled in the study (n=353). After a 12-hour fast, venous glucose, insulin, cholesterol, triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and uric acid were measured and full blood count was performed in all subjects. The TG/LDL ratio, the AST/platelet ratio index (APRI score) and the Homeostatic Model of Assessment-Insulin Resistance (HOMA-IR) were calculated. All patients underwent abdominal ultrasound examination to assess heaptosteatosis. Results: Of 353 patients, median age 12.5 (range: 6-17.9) years, 210 (59%) patients had US-proven hepatosteatosis. Female gender reduced the risk of steatosis 2.08 fold (p=0.005), one unit increase in HDL reduced the risk of steatosis 1.02 fold (p=0.042) and one unit increase in the BMI led to a 1.11 fold (p=0.002) increase in the risk of steatosis. Conclusion: Gender, BMI and HDL were found to be predictors of steatosis. Male patients with low HDL and high BMI are at greater risk of steatosis and should be carefully examined for the presence of NAFLD.

Anahtar Kelimeler

Fatty liver, childhood, high density lipoprotein, hepatosteatosis, obesity

Kaynakça

• References 1. Chalasani N, Younossi Z, Lavine JE, et al. American Association for the Study of Liver Diseases; American College of Gastroenterology; American Gastroenterological Association. The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Am J Gastroenterol. 2012;107:811-26. 2. Schwimmer JB, Deutsch R, Kahen T, et al. Prevalence of fatty liver in children and adolescents. Pediatrics. 2006;118:1388-93. 3. Valerio G, Licenziati MR, Iannuzzi A, Franzese A, Siani P, et al. Insulin resistance and impaired glucose tolerance in obese children and adolescents from Southern Italy. Nutr Metab Cardiovasc Dis 2006;16:279–84. 4. Day CP, Saksena S. Non-alcoholic steatohepatitis: definitions and pathogenesis. J Gastroenterol Hepatol. 2002;17:377-84. 5. Karlas T, Petroff D, Garnov N, et al. Non-invasive assessment of hepatic steatosis in patients with NAFLD using controlled attenuation parameter and 1H-MR spectroscopy. PLoS One. 2014;17;9:e91987 6. Feldstein AE, Alkhouri N, De Vito R, et al. Serum cytokeratin-18 fragment levels are useful biomarkers for nonalcoholic steatohepatitis in children. Am J Gastroenterol. 2013;108:1526-31. 7. Lombardi R, Pisano G, Fargion S. Role of Serum Uric Acid and Ferritin in the Development and Progression of NAFLD. Int J Mol Sci. 2016 Apr 12;17(4):548. 8. Alkhouri N, McCullough AJ. Noninvasive Diagnosis of NASH and Liver Fibrosis Within the Spectrum of NAFLD. Gastroenterol Hepatol. 2012;8:661-8. 9. Kurtoglu S, Hatipoglu N, Mazicioglu M, Kendirci M, Keskin M, Kondolot M. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Ped Endo 2010;2(3): 100-6. 10. Sahin NM, Kinik ST, Tekindal MA. OGTT results in obese adolescents with normal HOMA-IR values. J Pediatr Endocr Met 2013;26(3-4): 285-291. 11. de Ridder CM, Bruning CF, Zonderland ML, Thijssen JHH, Bonfrer JMG, Blankenstein MA, Huisveld IA, Erich WBM. Body fat mass, body fat distribution and plasma hormones in early puberty in females. J Clin Endocrinol Metab 1990;70(4): 888-893. 12. Cohen D, Gonzales-Pacheco D, Myers O. Relationships Between Alanine Aminotransferase, Serum Triglycerides, Body Mass Index and Nonalcoholic Fatty Liver Disease in an Outpatient Pediatric Clinic Population. J Pediatr Nurs. 2016;31:152-8. 13. Arslan N, Büyükgebiz B, Oztürk Y, et al. Fatty liver in obese children: prevalence and correlation with anthropometric measurements and hyperlipidemia. Turk J Pediatr. 2005;47:23-7. 14. Fonvig CE, Chabanova E, Ohrt JD, et al. Multidisciplinary care of obese children and adolescents for one year reduces ectopic fat content in liver and skeletal muscle.BMC Pediatr. 2015;15-196. 15 Ozkol M, Ersoy B, Kasirga E, et al. Metabolic predictors for early identification of fatty liver using doppler and B-mode ultrasonography in overweight and obese adolescents. Eur J Pediatr. 2010;169:1345-52. 16. Alkassabany YM, Farghaly AG, El-Ghitany EM. Prevalence, risk factors, and predictors of nonalcoholic fatty liver disease among schoolchildren: a hospital-based study in Alexandria, Egypt. Arab J Gastroenterol. 2014;15:76-81. 17. Chan DF, Li AM, Chu WC, et al. Hepatic steatosis in obese Chinese children. Int J Obes Relat Metab Disord. 2004;28:1257-63. 18. Eminoğlu TF, Camurdan OM, Oktar SO, et al. Factors related to non-alcoholic fatty liver disease in obese children.Turk J Gastroenterol. 2008;19:85-91. 19. Fu CC, Chen MC, Li YM, et al. The risk factors for ultrasound-diagnosed non-alcoholic fatty liver disease among adolescents. Ann Acad Med Singapore. 2009 ;38:15-7. 20. Sartorio A, Del Col A, Agosti F, et al. Predictors of non-alcoholic fatty liver disease in obese children. Eur J Clin Nutr. 2007 ;61:877-83. 21. Uslusoy HS, Nak SG, Gülten M, Biyikli Z. Non-alcoholic steatohepatitis with normal aminotransferase values. World J Gastroenterol. 2009 Apr 21;15(15):1863-8. 22. Posadas-Sánchez R, Posadas-Romero C, Zamora-González J, et al. Lipid and lipoprotein profiles and prevalence of dyslipidemia in Mexican adolescents. Metabolism. 2007 ;56:1666-72. 23. Ten S, Maclaren N. Insulin resistance syndrome in children. J Clin Endocrinol Metab. 2004 ;89:2526-39. 24. Alkhouri N, Eng K, Lopez R, Nobili V.. Non-high-density lipoprotein cholesterol (non-HDL-C) levels in children with nonalcoholic fatty liver disease (NAFLD). Springerplus. 2014 Aug 5;3:407.