THE EFFECT OF FATTY LIVER DISEASE ON PORTAL VEIN FLOW IN OBESE ADOLESCENTS

Year 2023, , 294 - 300, 23.09.2023

Ayşe Aydınoğlu , Müge Atar , Hüseyin Aydın , Özgür Pirgon

https://doi.org/10.17343/sdutfd.1209036

Abstract

Objective
The increase in obesity in children has caused
nonalcoholic fatty liver disease to become the most
important chronic liver disease in the pediatric age
group. In this study, we aimed to evaluate the portal
diameter and blood flow velocity in obese children with
fatty liver (NAFLD) and to compare them with normal
healthy children.
Material and Method
71 obese adolescent patients aged 10-18 years were
divided into two groups (NAFLD group and non-
NAFLD group) according to the presence of elevated
transaminases and the presence of hepatosteatosis
on ultrasound. 30 healthy adolescents were included
in the study as the control group. Blood samples
were taken from each patient for fasting glucose,
insulin, transaminases, and thyroid functions. Insulin
resistance was calculated using the HOMA index.
Portal vein measurements were performed from the
main portal vein before bifurcation.
Results
The portal vein diameter (8.5 ± 0.9 mm) of the NAFLD
group was statistically significantly wide compared
to both the control group (7.8 ± 2.0 mm) and the
non-NAFLD obese group (7.6 ± 1.1 mm) (p= 0.004)
and (p= 0.002). There was no significant difference
between the non-NAFLD obese group and the control
group (p=0.460, p=0.214). There was no significant
difference between the groups in terms of portal vein
Vmax, Vmin, RI, S/D. Although there was no difference
in portal vein diameter in the obese groups classified
according to insulin resistance, Vmax (33.9 ± 10.3 and
28.6 ± 10.6 cm/sec, p= 0.03) and Vmin (24.8 ± 6.2 and
20.5 ± 5.5 cm/sec) were significantly different in the
insulin resistance group.
Conclusion
In this study, it was determined that portal vein diameter
and flow velocities (Vmax and Vmin) increased in
obese adolescents with NAFLD. Thus, we suggest
that resistance develops in hepatic venous flow due
to hepatic portal vein steatosis, especially in obese
patients with insulin resistance in adolescence. This
finding suggests that when fatty liver continues, portal
diameter will increase in adulthood, leading to portal
hypertension.

Keywords

obesity, hepatosteatosis, doppler ultrasonography

OBEZ ADOLESANLARDA YAĞLI KARACİĞER HASTALIĞININ PORTAL VEN AKIMINA ETKİSİ

Abstract

Amaç
Çocuklarda obezitenin artması, nonalkolik yağlı karaciğer
hastalığının pediatrik yaş grubunda en önemli
kronik karaciğer hastalığı haline gelmesine neden
olmuştur. Bu çalışmada alkolik olmayan karaciğer
yağlanması (NAFLD) olan obez çocuklarda portal ven
çapı ve kan akım hızını değerlendirmesi ve normal
sağlıklı çocuklarla karşılaştırması amaçlanmıştır.
Gereç ve Yöntem
10-18 yaş arası 71 obez adolesan hasta, transaminaz
yüksekliği ve ultrasonda hepatosteatoz (NAFLD grubu
ve NAFLD olmayan grup) varlığına göre iki gruba
ayrıldı. Kontrol grubu olarak 30 sağlıklı ergen çalışmaya
dahil edildi. Her hastadan açlık glukozu, insülin,
transaminaz düzeyleri ve tiroid fonksiyonları için kan
örnekleri alındı. İnsülin direnci HOMA indeksi kullanılarak
hesaplandı. Portal ven ölçümleri, bifurkasyon
öncesi ana portal venden yapıldı.
Bulgular
NAFLD grubunda portal ven çapı (8.5 ± 0.9 mm) hem
kontrol grubuna (7.8 ± 2.0 mm) hem de NAFLD olmayan
obez gruba (7.6 ± 1.1 mm) göre istatistiksel
olarak anlamlı derecede geniş olarak saptandı (p=
0.004) ve (p=0.002). NAFLD olmayan obez grup ile
kontrol grubu arasında anlamlı fark yoktu (p=0.460,
p=0.214). Portal ven Vmax, Vmin, RI, S/D açısından
gruplar arasında anlamlı fark yoktu. İnsülin direncine
göre sınıflandırılan obez gruplarda portal ven çaplarında
farklılık olmamasına rağmen, Vmax (33.9 ± 10.3
ve 28.6 ± 10.6 cm/sn, p= 0.03) ve Vmin (24.8 ± 6.2
ve 20.5 ± 5.5 cm/sn) insülin direnci grubunda önemli
ölçüde farklıydı.
Sonuç
Bu çalışmada NAFLD olan obez adolesanlarda portal
ven çapı ve akım hızlarının (Vmax ve Vmin) arttığı
belirlendi. Bu nedenle özellikle ergenlik döneminde
insülin direnci olan obez hastalarda hepatik portal ven
steatozuna bağlı hepatik venöz akımda direnç geliştiği
düşünüldü. Bu bulgu, karaciğer yağlanmasının
devam etmesi durumunda erişkin dönemde portal çapının
artacağını ve bunun da portal hipertansiyona yol
açacağını düşündürmektedir.

Keywords

obezite, hepatosteatoz, doppler ultrasonografi

References

• 1. Donohoue PA. Obesity In: Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics 17th ed. Philadelphia: W.B. Saunders, 2004: 173-177
• 2. Öztora S. Determination of Obesity Prevalence in Primary School Children and Investigation of Risk Factors, Specialization Thesis, Istanbul, 2005.
• 3. Eker E, Şahin M. Approach to Obesity in Primary Care. TTB STED 2002;11:7-246.
• 4. Sonsuz A. Nonalcoholic Liver Fatigue, Istanbul University Cerrahpasa Faculty of Medicine Continuing Medical Education Activities, Symposium Series: 58, Istanbul 2007; 91-98.
• 5. Lavine JE, Schwimmer JB. Pediatric non-alcoholic steatohepatitis. In: Farrell G, George J, Hall P, McCollough A, eds. Non-alcoholic Steatohepatitis. Oxford, England: Blackwell Publishing,2004:229-240.
• 6. Schwimmer JB, Deutsch R, Rauch JB, Behling C, Newbury R, Lavine JE. Obesity, insulin resistance, and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease. J Pediatr 2003;143:500-505.
• 7. Kimm SY, Obarzanek E. Childhood obesity: a new pandemic of the new millennium. Pediatrics 2002;110:1003-1007.
• 8. McCullough AJ. Update on nonalcoholic fatty liver disease. J Clin Gastroenterol. 2002 Mar;34(3):255-62.
• 9. Adams LA, Lymp JF, St Sauver J, Sanderson SO, Lindor KD, Feldstein A, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology. 2005 Jul;129(1):113-21.
• 10. Kunutsor SK, Apekey TA, Walley J. Liver aminotransferases and risk of incident type 2 diabetes: a systematic review and meta-analysis. AmJ Epidemiol. 2013;178(2):159–171
• 11. Poynard T, Ratziu V, Naveau S, Thabut D, Charlotte F, Messous D et al. The diagnostic value of biomarkers (SteatoTest) for the prediction of liver steatosis. Comp Hepatol 2005; 4:10.
• 12. Wieckowska A, Feldstein AE. Diagnosis of nonalcoholic fatty liver disease: invasive versus noninvasive. Semin Liver Dis 2008; 28:386–395.
• 13. Haktanir A, Cihan BS, Celenk C, Cihan S. Value of Doppler sonography in assessing the progression of chronic viral hepatitis and in the diagnosis and grading of cirrhosis. J Ultrasound Med, 2005;24(3):311-21.
• 14. Haktanır A, Değirmenci B, Acar M, Yücel A, Albayrak R. Doppler Ultrasonographic Evaluation of Changes in Liver Blood Flow According to Age. Kocatepe Medical Journal 2005;6:37-41.
• 15. Zoli M, Magalotti D, Bianchi G. Total and functional hepatic blood flow decrease in parallel with aging. Age Aging, 1999;28:29-33.
• 16. Mutlu İN, Barut AY, Nazlı MA. Diagnostic Value of Color Doppler Ultrasonography in Portal Hypertension, Istanbul Medical Journal 2006:3;12-16
• 17. Cutfield WS, Jefferies CA, Jackson WE, Robinson EM, Hofman PL. Evaluation of HOMA and QUICKI as measures of insulin sensitivity in prepubertal children. Pediatr Diabetes. 2003;4:119–125.
• 18. 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;115:500-503.z
• 19. Zoli M, Merkel C, Saba C. Interobserver and inter-equipment variability of echo-Doppler sonographic evaluation of the superior mesenteric artery. J Ultrasound Med 1996;15:99-106.
• 20. Dietrich CF, Lee JH, Gottschalk R, Herrmann G, Sarrazin C, Caspary WF, et al. Hepatic and portal vein flow pattern in correlation with intrahepatic fat deposition and liver histology in patients with chronic hepatitis C. AJR Am J Roentgenol. 1998 Aug;171(2):437-43.
• 21. Balci A, Karazincir S, Sumbas H, Oter Y, Egilmez E, Inandi T. Effects of diffuse fatty infiltration of the liver on portal vein flow hemodynamics. JClin Ultrasound. 2008;36:134–140
• 22. Erdogmus B, Tamer A, Buyukkaya R, Yazici B, Buyukkaya A, Korkut E, et al. Portal vein hemodynamics in patients with non-alcoholic fatty liver disease. Tohoku J Exp Med. 2008 May;215(1):89-93.
• 23. Webb LJ, Berger LA, Sherlock S. Grey-scale ultrasonography of portal vein. Lancet. 1977 Oct 1;2(8040):675-7.
• 24. Bolondi L, Gandolfi L, Arienti V, Caletti GC, Corcioni E, Gasbarrini G, et al. Ultrasonography in the diagnosis of portal hypertension: diminished response of portal vessels to respiration. Radiology. 1982 Jan;142(1):167-72.
• 25. Goyal AK, Pokharna DS, Sharma SK. Ultrasonic measurements of portal vasculature in diagnosis of portal hypertension. A controversial subject reviewed. J Ultrasound Med. 1990 Jan;9(1):45-8.
• 26. Er R, Ünal Ö, Tuncer İ, Harman M, Etlik O. Portal and Hepatic Veins in Portal Hypertension: Doppler US Findings. Van Med J. 2000; 7(3): 94-97.
• 27. Mihmanli I, Kantarci F, Yilmaz MH, Gurses B, Selcuk D, Ogut G, et al. Effect of diffuse fatty infiltration of the liver on hepatic artery resistance index. J Clin Ultrasound. 2005 Mar-Apr;33(3):95-9.
• 28. Demir ME. Ultrasound evaluation of metabolic syndrome patients with hepatosteatosis. J Clin Exp Invest. 2013;4(2), 153- 158