Hepatic steatosis and severity‐related factors in obese children

Navarro-Jarabo, J.M.; Ubiña-Aznar, Esther; Ceballos, L. Tapia; Ortiz-Cuevas, Carmen; Pérez-Aisa, Maria Ángeles; Rivas-Ruiz, Francisco; Andrade, Raúl J.; Perea-Milla, Emilio

doi:10.1111/jgh.12276

Cited by 15 publications

(24 citation statements)

References 36 publications

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“…Given the broad confidence interval found, the association may or may not have clinical impact and it should be taken with caution. These findings were also demonstrated in a similar study by Navarro-Jarabo, et al [20], where a higher level of triglycerides and higher BMI were related to hepatic steatosis. In addition to this, we looked more closely at children with moderate to severe steatosis by US and we found that HDLC was lower in this group of patients, which can be related to insulin resistance [21].…”

Section: Discussionsupporting

confidence: 83%

Prevalence and risk factors for non-alcoholic fatty liver in children and youth with obesity

et al. 2017

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BackgroundNon- Alcoholic Fatty Liver (NAFL) is a spectrum of liver diseases (LD) that ranges from benign fatty infiltration of the liver to cirrhosis and hepatic failure. Hepatic ultrasound (US) and serum alanine aminotransferase (ALT) are often used as markers of NAFL. Our aim is to describe prevalence of NAFL and associated findings on ultrasound (US) and biochemical parameters in a population of children and adolescents with obesity at the Children’s Hospital of Eastern Ontario.MethodsChildren with Obesity (BMI >95th percentile) ages 8–17 years presenting to the Endocrinology and Gastroenterology clinics, without underlying LD were prospectively recruited from 2009 to 2012. Fasting lipid profile, HOMA IR) and serum adiponectin levels were measured. NAFL was defined as ALT > 25 and >22 IU/mL (males and females respectively) and/or evidence of fatty infiltration by US. Logistic regression was performed to assess associations.Results97 children with obesity included in the study (Male 43%). Mean age was 12.9 ± 3.2 years (84% were older than 10 y). Mean BMI-Z score was 3.8 ± 1.4. NAFL was identified in 85%(82/97) of participants. ALT was elevated in 61% of patients. Median triglyceride (TG) level was higher in children with NAFL(1.5 ± 0.9 vs. 1.1 ± 0.5 mmol/L, p = 0.01). Total cholesterol, HDL, LDL and Non HDL cholesterol were similar in both groups(p = 0.63, p = 0.98, p = 0.72 and p = 0.37 respectively). HOMA IR was ≥3.16 in 53% of children(55% in those with NAFL and 40% in those without NAFL). Median serum adiponectin was 11.2 μg/ml(IQR 7.3–18.3) in children with NAFL vs. 16.1 μg/ml(IQR 9.0–21.9) in those without NAFL(p = 0.23). Liver US was reported as normal in 30%, mild fatty infiltration in 38%, moderate in 20% and severe in 12%. TG were significantly higher(1.5 mmol/L vs. 1.0 mmol/L, p < 0.01) and HDL-C was lower(1.0 mmol/L vs. 1.1 mmol/L, p = 0.05) in children with moderate and severe NAFL by US. BMI-Z score, HOMA IR, serum adiponectin and HDL levels were not associated with NAFL, however TG were significantly associated(OR = 3.22 (95% CI: 1.01–10.25, p = 0.04)).ConclusionNAFL is highly prevalent in obese children and youth. Elevated TG levels are associated with NAFL; these findings may serve as a noninvasive screening tool to help clinicians identify children with obesity needing liver biopsy and/or more aggressive therapeutic interventions.

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Section: Discussionsupporting

confidence: 83%

Prevalence and risk factors for non-alcoholic fatty liver in children and youth with obesity

et al. 2017

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“…The prevalence of the steatotic liver is rapidly increasing worldwide reaching almost 30% of the total population in some countries [1], [2], with incidences rapidly rising in the pediatric population [3]. Hepatic steatosis is largely considered the hepatic manifestation of the metabolic syndrome [4], although, in fact, recent studies have shown that it actually precedes the development of metabolic syndrome [5] and its prevalence is expected to rise along with the number of overweight and obese people [6].…”

Section: Liver Transplantsmentioning

confidence: 99%

ROS homeostasis, a key determinant in liver ischemic-preconditioning

Prieto

Monsalve

2017

Redox Biology

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Reactive Oxygen Species (ROS) are key mediators of ischemia-reperfusion injury but also required for the induction of the stress response that limits tissue injury and underlies the protection provided by ischemic-preconditioning protocols. Liver steatosis is an important risk factor for liver transplant failure. Liver steatosis is associated with mitochondrial dysfunction and excessive mitochondrial ROS production. Studies aiming at decreasing the sensibility of the steatotic liver to ischemia-reperfusion injury using pre-conditioning protocols, have shown that the steatotic liver has a reduced capacity to respond to these protocols. Recent studies indicate that these effects are related to a reduced capacity of the steatotic liver to respond to elevated ROS levels following reperfusion by inducing a compensatory response. This failure to respond to ROS is associated with reduced levels of antioxidants, mitochondrial damage, hepatocyte cell death, activation of the immune system and induction of pro-fibrotic mediators.

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“…Therefore, the risk factors associated with steatosis in obese children should be identified, especially for the most severe forms of steatosis. Our research group has recently shown that steatosis can be detected by Insulin resistance and the metabolic syndrome are related to the severity of steatosis in the pediatric population with obesity ultrasonography in 34% of children who are overweight or obese (14). The study also showed that the group of patients without steatosis and the group with mild steatosis had similar characteristics.…”

Section: Introductionmentioning

confidence: 72%

“…The study was performed in a subgroup of obese children from a cohort of a previous study that were referred to a childhood obesity unit (14). Glucose homeostasis and MetS characteristics were analyzed to determine the factors associated with severe steatosis confirmed by ultrasonography.…”

Section: Methodsmentioning

confidence: 99%