Hepatic steatosis in obese Chinese children

Abstract

OBJECTIVES:The aims of our study were: (1) to determine the prevalence of asymptomatic hepatic steatosis and presumed nonalcoholic steatohepatitis, in our local population of obese Chinese children referred for medical assessment; and (2) to assess the correlation between severity of ultrasonographic hepatic steatosis and degree of obesity, insulin resistance and serum biochemical abnormalities. DESIGN: Cross-sectional study. METHODS: In total, 84 obese children, 25 girls and 59 boys with median age and body mass index (BMI) of 12.0 years (interquartile range (IR): 9.5-14.0) and 30.3 kg/m 2 (IR: 27.1-33.4), respectively, referred for medical assessment were studied. All subjects underwent physical examination, anthropometric and dual energy X-ray absorptiometry (DEXA) scan measurements and real-time ultrasonographic (US) examination of the liver. Fasting blood samples were collected for the measurement of liver function, hepatitis status, levels of serum glucose and insulin and lipid profile. Degree of fatty infiltration of the liver was graded according to ultrasonic appearance of liver echotexture, liver-diaphragm differentiation in echo amplitude, hepatic echo penetration and clarity of hepatic blood vessels. RESULTS: All recruited subjects had no history of alcohol abuse and tests for Hepatitis B or C virus were negative. Thorough examination showed all of them to be in general good health without signs of chronic liver disease. Hepatic steatosis identified by defined ultrasonic appearances was diagnosed in 65 subjects (77%); 17 girls and 48 boys. The severity of fatty liver was positively related to anthropometric measurements including BMI, waist and hip circumference, subscapular skinfold thickness; insulin resistance markers [QUICKI and homeostasis model assessment (HOMA)], and hypertriglyceridaemia. Multvariate ordinal regression analysis showed that BMI and raised alanine aminotransferase (ALT) were positively associated with fatty liver. Combination of hepatic steatosis with raised ALT (presumptive NASH) was found in 19 subjects (24%). This group of patients had significantly higher waist hip ratio and conicity index compared to those with isolated hepatic steatosis. Boys with presumed NASH were also found to have significantly higher insulin resistance. CONCLUSION: Nonalcoholic fatty liver disease (NAFLD) was common among our cohort of obese children referred for medical assessment. The prevalence of simple steatosis and presumed NASH was 77 and 24%, respectively. The severity of US steatosis was positively correlated with BMI, raised ALT, insulin resistance and hypertryglyceridaemia. Ultrasonography being noninvasive and readily available could be used for the monitoring of the progression of hepatic steatosis. Further longitudinal studies are required to determine the natural disease progression and the role of insulin resistance and other factors in the pathophysiology of NAFLD.

Nonalcoholic fatty liver disease: a challenge for pediatricians

“…6,26,28 Insulin resistance Obesity and type II diabetes are associated with hyperinsulinemia and IR, which may inhibit fatty acid oxidation and increase the presentation of fatty acids to the liver. 19 Markers of IR, are present in both obese and normal weight NAFLD patients. 32,33 Hyperinsulinemia is a principal contributor to the development of fatty liver in childhood obesity.…”

“…27,29 These 'fibrosis predictors' have ranged from 10 to 25% of elevated ALT in obese adolescence to 52-77% bright liver, in sonography, in different studies in several countries. 10,13,19,30 Fatty liver patients are at risk of developing diabetes or impaired glucose tolerance in long term. 5,20,24 Accordingly, NASH patients display elevated gamma-glutamyltransferase levels, high-density lipoprotein cholesterol below the fifth percentile for their age and sex.…”

“…9,13,16,18 About two-thirds of obese adults and half of obese children may have fatty liver. 17,19,21 When compared with their normal counterparts, overweight and obese adolescents had 4.14 and 5.98 times the risk of having NAFLD. 22 In reported clinical series of pediatric NAFLD, the mean age was between 11 and 13 years.…”

“…[14][15][16][17][18] Measurement of abdominal subcutaneous fat thickness by ultrasonography could be a good estimate for liver involvement, especially in obese subjects. [19][20][21][22][23] Population-based approaches by this method, suggests an overall prevalence of at least 3% for suspected fatty liver disease among children and adolescents in the United States and Asia. 9,17 The histology of the liver, the most important criterion for diagnosis is usually not being used for screening.…”

Prevalence of non-alcoholic fatty liver disease in children and relationship to metabolic syndrome, insulin resistance, and waist circumference

“…The global epidemic of childhood obesity has become a serious public health concern [1], and recent studies suggest that the prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing in children [2,3], especially in obese children [4,5]. This condition is considered to be the most common form of chronic liver disease in the pediatric population [6].…”