Functional and Morphological Vascular Changes in Pediatric Nonalcoholic Fatty Liver Disease

Pacifico, Lucia; Anania, Caterina; Martino, Francesco De; Cantisani, Vito; Pascone, Roberto; Marcantonio, Andrea; Chiesa, Claudio

doi:10.1002/hep.23890

Cited by 86 publications

(87 citation statements)

References 35 publications

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“…Separate analysis of obese children showed that low FMD percentage was not significantly associated with BMI SDS, high IR, high ALT levels, or MetS and NAFLD. This result contradicts the result of a recent study by Pacifico et al, which reports that obese children with US-diagnosed NAFLD and elevated ALT levels had significantly lower FMD response and increased CIMT, which were independent of other cardiovascular risk factors and MetS, than obese children without NAFLD (6). Thus, they concluded that obese children exhibited more functional and morphological vascular changes than lean healthy controls and that FMD response decreased independently of MetS and NAFLD (6).…”

Section: Discussioncontrasting

confidence: 63%

“…In obese children and adolescents with NAFLD, atherogenic condition is associated with the features of MetS such as abnormal values of HDL cholesterol, insulin, TGs, and BP. (6,(16)(17)(18)(19). Approximately 90% patients with NAFLD have at least one feature of MetS, and approximately 33% patients are diagnosed as having MetS by considering NAFLD as a hepatic manifestation of MetS (20).…”

Section: Discussionmentioning

confidence: 99%

“…In adults, the severity of liver disease is associated with decreased endothelial function (5); however, limited data are available on en-dothelial dysfunction in pediatric patients with NAFLD. Right carotid intima-media thickness (CIMT) and brachial flow-mediated dilation (FMD) are preclinical markers of vascular health (6). The present study aimed to investigate the relationship between NAFLD and cardiovascular risk factors and increased risk of atherosclerosis in obese children with NAFLD.…”

Section: Introductionmentioning

confidence: 98%

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Carotid intima-media thickness and flow-mediated dilation in obese children with non-alcoholic fatty liver disease

Torun

Aydın²,

Gökçe³

et al. 2015

Turk J Gastroenterol

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Background/Aims: This study aimed to understand the role of non-alcoholic fatty liver disease (NAFLD) in increasing the risk of atherosclerosis in obese pediatric patients. Materials and Methods: The study included 109 obese children (age, 9-15 years) and a control group comprising 44 healthy age-and gender-matched children with normal weight. NAFLD was diagnosed using conventional ultrasound (US) examination. Both right carotid intima-media thickness (CIMT) and flow-mediated dilation (FMD) were assessed in addition to anthropometric measures and serum biochemical parameters, including lipid profile and fasting glucose and insulin levels. Homeostatic model assessment of insulin resistance (HOMA-IR) was calculated as a measure of insulin resistance. Results: Mean age and gender distributions were similar in the obese children and control group (p=0.168 and p=0.705, respectively). Median body mass index standard deviation scores of obese children with grade II-III NAFLD were significantly higher than those of obese children without hepatosteatosis (p<0.001). Median total cholesterol levels were similar in all the groups (p=0.263). Low-density lipoprotein cholesterol and triglyceride levels increased and high-density lipoprotein cholesterol levels decreased significantly as the grade of steatosis increased (p<0.001, p<0.05, and p=0.05, respectively). Median alanine aminotransaminase (ALT) and HOMA-IR levels of obese children with grade II-III NAFLD were significantly higher than those of obese children without NAFLD (p=0.01) and obese children with grade I NAFLD (p=0.001). CIMT was significantly correlated with the grade of steatosis (p<0.001) and level of ALT (p=0.005). Linear regression analysis showed that the grade of hepatosteatosis had a significant effect on CIMT. FMD decreased as the grade of hepatosteatosis increased, but it did not reach a significant level. Conclusion: The obese children with hepatosteatosis showed increased CIMT, as indicated by the grade of steatosis, compared with healthy controls and obese children without hepatosteatosis. FMD was not superior to CIMT in predicting the risk of early atherosclerosis.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

Carotid intima-media thickness and flow-mediated dilation in obese children with non-alcoholic fatty liver disease

Torun

Aydın²,

Gökçe³

et al. 2015

Turk J Gastroenterol

View full text Add to dashboard Cite

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“…Assessment of FMD was performed as previously reported (36). Briefly, brachial artery diameters were measured before and then 45 and 70 s after 5 min of reduced blood flow (induced by inflation of a standard sphygmomanometer cuff to at least 50 mmHg above resting systolic BP).…”

Section: Subclinical Atherosclerosismentioning

confidence: 99%

Low 25(OH)D3 levels are associated with total adiposity, metabolic syndrome, and hypertension in Caucasian children and adolescents

Pacifico

Anania

Osborn

et al. 2011

European Journal of Endocrinology

161

122

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Objectives: Evidence of the association between vitamin D and cardiovascular risk factors in the young is limited. We therefore assessed the relationships between circulating 25-hydroxyvitamin D 3 (25(OH)D 3 ) and metabolic syndrome (MetS), its components, and early atherosclerotic changes in 452 (304 overweight/obese and 148 healthy, normal weight) Caucasian children. Methods: We determined serum 25(OH)D 3 concentrations in relation to MetS, its components (central obesity, hypertension, low high-density lipoprotein (HDL)-cholesterol, hypertriglyceridemia, glucose impairment, and/or insulin resistance (IR)), and impairment of flow-mediated vasodilatation (FMD) and increased carotid intima-media thickness (cIMT) -two markers of subclinical atherosclerosis. Results: Higher 25(OH)D 3 was significantly associated with a reduced presence of MetS. Obesity, central obesity, hypertension, hypertriglyceridemia, low HDL-cholesterol, IR, and MetS were all associated with increased odds of having low 25(OH)D 3 levels, after adjustment for age, sex, and Tanner stage. After additional adjustment for SDS-body mass index, elevated blood pressure (BP) and MetS remained significantly associated with low vitamin D status. The adjusted odds ratio (95% confidence interval) for those in the lowest (!17 ng/ml) compared with the highest tertile (O27 ng/ml) of 25(OH)D 3 for hypertension was 1.72 (1.02-2.92), and for MetS, it was 2.30 (1.20-4.40). A similar pattern of association between 25(OH)D 3 , high BP, and MetS was observed when models were adjusted for waist circumference. No correlation was found between 25(OH)D 3 concentrations and either FMD or cIMT. Conclusions: Low 25(OH)D 3 levels in Caucasian children are inversely related to total adiposity, MetS, and hypertension.

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“…Villanova's [31] study described a correlation between NAFLD severity and impaired FMD; in fact, lower FMD value were observed in patients with NAFLD/NASH. Finally, among 250 obese children, those with NAFLD and transaminase elevation had significantly impaired FMD [32] . Despite FMD has been shown to be able to predict CV events in some settings [33] , it is not commonly used in clinical practice mostly due to its variability.…”

Section: Fmdmentioning

confidence: 94%

Oxidative stress: New insights on the association of non-alcoholic fatty liver disease and atherosclerosis

Polimeni

Ben

Baratta

et al. 2015

WJH

174

137

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Non-alcoholic fatty liver disease (NAFLD) represents the most common and emerging chronic liver disease worldwide. It includes a wide spectrum of liver diseases ranging from simple fatty liver to non-alcoholic steatohepatitis (NASH), which may progress to fibrosis and more severe liver complications such as cirrhosis, hepatocellular carcinoma and liver mortality. NAFLD is strongly associated with obesity, insulin resistance, hypertension, and dyslipidaemia, and is now regarded as the liver manifestation of the metabolic syndrome. The increased mortality of patients with NAFLD is primarily a result of cardiovascular disease and, to a lesser extent, to liver related diseases. Increased oxidative stress has been reported in both patients with NAFLD and patient with cardiovascular risk factors. Thus, oxidative stress represents a shared pathophysiological disorder between the two conditions. Several therapeutic strategies targeting oxidative stress reduction in patients with NAFLD have been proposed, with conflicting results. In particular, vitamin E supplementation has been suggested for the treatment of non-diabetic, non-cirrhotic adults with active NASH, although this recommendation is based only on the results of a single randomized controlled trial. Other antioxidant treatments suggested are resveratrol, silybin, L-carnitine and pentoxiphylline. No trial so far, has evaluated the cardiovascular effects of antioxidant treatment in patients with NAFLD. New, large-scale studies including as end-point also the assessment of the atherosclerosis markers are needed.

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Functional and Morphological Vascular Changes in Pediatric Nonalcoholic Fatty Liver Disease

Cited by 86 publications

References 35 publications

Carotid intima-media thickness and flow-mediated dilation in obese children with non-alcoholic fatty liver disease

Carotid intima-media thickness and flow-mediated dilation in obese children with non-alcoholic fatty liver disease

Low 25(OH)D3 levels are associated with total adiposity, metabolic syndrome, and hypertension in Caucasian children and adolescents

Oxidative stress: New insights on the association of non-alcoholic fatty liver disease and atherosclerosis

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