Şişman çocuk ve ergenlerde alkolik olmayan yağlı karaciğer hastalığı

Abstract

Aim:To determine the prevelance of the non-alcoholic fatty liver in obese children. Material and Method: Medical records of 161 obese children (age 4-18 yrs) who were investigated for non-alcoholic fatty liver by USG were analysed retrospectively. Their findings of physical examination and antropometric measurements, presence of acanthosis nigricans, pubertal status and results of laboratory analysis were evaluated. The study protocol was approved by the Osmangazi University Ethical Committee (2010/13). Results: Hepatosteatosis was found in 40% of the patients by ultrasonography. Elevation of serum alanine aminotransferase (≥40 U/L) was found in 35% of the patients with steatosis. These patients had higher body mass index, HOMA-IR (Homeostasis model of assessment-insulin resistance) and aspartat aminotransferase, alanine aminotransferase, insulin and triglyceride levels and lower HDL-C levels and higher acanthosis nigricans prevalences than the patients without steatosis. Patients with elevated alanine aminotransferase levels had significantly higher trygliceride and lower HDL-C levels than the patients with normal alanine aminotransferase levels. Steatosis prevalences were 32% in girls and 54% in boys (p<0.01). The prevalence of elevated alanine aminotransferase was found higher in prepubertal children (p<0.05), but, the steatosis prevalences were not different between prepubertal-pubertal children and between prepubertal girls and boys. Pubertal boys had higher steatosis prevalence than pubertal girls (p<0.05). The prevalence of steatosis was higher in children with acanthosis nigricans (p=0.001). The prevalences of steatosis and elevated alanine aminotransferase levels were not different between children with and without insulin resistance. In a logistic regression model, sex, body mass index and HDL-C were the determinants of steatosis and only HDL-C were related with alanine aminotransferase levels. Conclusions: High prevalences of hepatosteatosis and elevated alanine aminotransferase levels are found in obese children and adolescents. Gender, the degree of obesity and dyslipidemia are more important determinants of steatosis than insulin resistance. (Turk Arch Ped 2012; 47: 172-178)