Nonalcoholic fatty liver disease in children with obesity– observations from one clinical centre in the Western Pomerania region

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a growing health problem in the pediatric population, due to the constantly increasing percentage of children with obesity. The objective of the study was to assess the occurrence of NAFLD based on ultrasound (USG) analysis and the use of alanine aminotransferase (ALT) in children with overweight and obesity depending on glucose tolerance. Medical records of 228 consecutive patients aged 2-18 years with overweight and obesity were reviewed retrospectively. Based on the oral glucose tolerance test children were divided into groups according to the severity of carbohydrate metabolism disorders. ALT, lipid parameters and insulin sensitivity indices HOMA, Matsuda and Quicki were analyzed. NAFLD was diagnosed (based on the USG) in 51 patients (23.61%) - the incidence in the impaired glucose tolerance (IGT) and type 2 diabetes (T2DM) group was significantly higher when compared to ones without glucose intolerance. Because of extreme values of metabolic parameters in TDM2 children being outliers, they were not considered in the statistical analysis of the study. 22 (11.58%) patients had elevated ALT values, of which 12 (54.55%) had hepatic steatosis features on ultrasound. 72.73% (n=32) patients with fatty liver features on USG had ALT values considered normal with cut-off point 42 U/l accepted in this study. Almost every fourth obese child in the study group presents features of fatty liver in ultrasound examination. Although ultrasound is not recommended by North American Society For Pediatric Gastroenterology, Hepatology &Nutrition(NASPGHAN) for the diagnosis of NAFLD in children, it allows identifying a high percentage of children with features of fatty liver. This percentage increases significantly in children with glucose intolerance.

The Role of Vitamin D in Obese Children with Non-Alcoholic Fatty Liver Disease and Associated Metabolic Syndrome

“…Alteration of glucose, insulin, TG, HDLch and LDL values and cardiovascular problems are also indicated in other original studies or meta-analyses on MS from NAFLD [2,4,10,11,18,50,51].…”

“…These discrepancies may be due to the heterogeneity of the criteria used, as well as the mixed groups of children and adolescents [14]. In addition, NAFLD is more frequent in males after the age of 10 [2,11,48,49], in a ratio of almost 3:1 with females [2], possibly due to the accumulation of especially visceral fat in males, compared to females who could also have hormonal protection as they grow older [2,18].…”

“…NAFLD constitutes a spectrum of sequential entities represented by simple steatosis, non-alcoholic steatohepatitis (NASH) that can evolve into cirrhosis and cancer, the damage to hepatocytes, inflammation and fibrosis being the result of complex multistage two-hit or multihit pathogenic mechanisms, with the involvement of still unclear environmental, genetic and epigenetic factors [1,2,[4][5][6]8,[15][16][17]. Resistance of adipose tissue to insulin, oxidative stress, intestinal dysbiosis and disturbance of the intestine-liver axis constitute the mechanisms that maintain and advance NAFLD [1,4,11,16,18].…”

“…One of the many therapeutic possibilities that have been approached over time for the treatment of NAFLD is represented by the additional administration (supplementation) of vitamin D, with anti-inflammatory [21,27] and antioxidant effects [23], improving glucose tolerance/insulin resistance [28]. However, the results are controversial [28,29], so at the present time, the only approach that has proven its effectiveness in NAFLD in children is lifestyle improvement [4,7,11,18]. Despite this, there are some pharmacological agents approved by the United States Food and Drug Administration (FDA) for weight loss in children over 12 years old [19].…”

Amino acid profile in overweight and obese prepubertal children – can simple biochemical tests help in the early prevention of associated comorbidities?

“…MAFLD is a growing health problem in the pediatric population. Among simple, routinely performed laboratory tests, alanine aminotransferase (ALT) could be considered sufficient to diagnose MAFLD in these children and could predict MAFLD in the future ( 15 ). Another simple molecule that is measured routinely, uric acid (UA), is present in high concentrations in patients with metabolic syndrome when the latter is associated with endothelial dysfunction, inflammation, and hypertension.…”