Triglycerides and Alanine Aminotransferase as Screening Markers for Suspected Fatty Liver Disease in Obese Children and Adolescents

Abstract

Background/Aims: Metabolic syndrome (MS) and fatty liver disease (FLD) are on the rise. The association between these conditions in Brazilian youth is analyzed. Methods: 354 subjects (11.2 ± 3.1 years) were evaluated. FLD was suspected by ultrasound and computed tomography; weight and MS by BMI z-score and NCEP-ATPIII respectively. Results: Subjects were classified as: group 1 with suspected FLD and group 2 without and group 2 as ‘a’ (overweight/obese) and ‘b’ (normal weight). Comparing group 1 with 2a and 2b, differences in age (p = 0.016; p = 0.075), triglycerides (TG) (p = 0.021; p = 0.002), insulin (p = 0.652; p = 0.015) and homeostasis model assessment method of IR (HOMA-IR) (p = 0.737; p = 0.003) were found. Group 2a was divided into low/high alanine aminotransferase (ALT). A decrease in waist circumference and TG was found going from those with suspicion of FLD to obese with high and low ALT. Insulin and HOMA-IR in group 1 and high ALT were similar. Gender (OR 6.6; CI 1.9–22.5; p = 0.025), age (OR 1.3; CI 1.1–1.6; p = 0.006), TG (OR 10.4; CI 3.1–34.4; p = 0.005) were associated with suspected FLD. For every 10 U/l increase in ALT, there was a 4-fold greater chance of probable FLD (OR 4.01; CI 2.06–9.40; p < 0.001). Conclusion: Measurements of ALT and TG should be considered as screening for suspected FLD in overweight/obese youth.

Is triglyceride to high-density lipoprotein cholesterol ratio a surrogates for insulin resistance in youth?

“…Others studies conducted by our group clearly showed that childhood obesity has high prevalence in developing countries [22] and leads to several cardio metabolic disturbances, such as increase in blood pressure [23,24] presence of fatty liver disease [25], IR [26], metabolic syndrome and subclinical inflammation [17]. Therefore, excessive weight is related to a preatherosclerosis status that starts early in life and is associated with increased mortality due to CVD [27].…”

Risk Factors for Non-Alcoholic Fatty Liver Disease in Obese Children

“…These findings supported the hypothesis that hyperinsulinemia is a contributor to the development of fatty liver, and hypertriglyceridemia facilitates liver steatosis, thereafter steatitis develops with elevated transaminase levels. As emphasized in Oliveira's study [2], we suggested that simultaneous measurement of triglyceride and ALT levels in obese children could help to identify suspected FLD.…”

“…Olivera et al [2] evaluated 354 children and adolescents having FLD, and found 10 subjects with suspected FLD. Subjects with suspected FLD were found to have higher levels of triglyceride, ALT, AST, mean fasting insulin levels, and HOMA-IR values when compared with the subjects without FLD.…”

Marcadores de síndrome metabólico como predictores de elevación de alanino aminotransferasa en niños

“…En la literatura se ha demostrado que la ALT y los triglicéridos están signifi cativamente elevados en niños con HGNA en comparación con aquellos con hígado normal 17 y por tanto, se ha propuesto la medición de ambos como un tamizaje apropiado de HGNA en niños con IMC > 85% 18 .…”