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Wang Y, Luo S, Wang K, Zhang Y. Gender and educational stage-specific association of birth weight with overweight and obesity among children and adolescents aged 7-18 years: a school-based cross-sectional study. BMJ Open 2025; 15:e097584. [PMID: 40216428 PMCID: PMC11987119 DOI: 10.1136/bmjopen-2024-097584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Accepted: 02/28/2025] [Indexed: 04/14/2025] Open
Abstract
OBJECTIVES To investigate the associations between birth weight and overweight/obesity in school-aged children and adolescents according to different gender and educational stages, and explore the interactions among the lifestyle factors. DESIGN Cross-sectional study. SETTING Henan Province in China. PARTICIPANTS A total of 27 009 children and adolescents aged 7-18 years were included. PRIMARY OUTCOME MEASURES Anthropometric parameters were measured and characteristics were collected by questionnaires. Logistic regression analysis was used to estimate the ORs and corresponding 95% CIs of overweight/obesity with birth weight. The relative excess risk due to interaction (RERI) and the attributable proportion of interaction (AP) indices were used to measure additive interaction. RESULTS In the adjusted logistic regression models, the overall population with high birth weight (HBW) (adjusted ORs 2.866, 95% CI 1.563 to 3.728) had an increased risk of overweight/obesity compared with those with normal birth weight (NBW), and the associations differed by gender-specific and educational stage-specific factors. When stratified by gender, children and adolescents with HBW had a higher risk of overweight/obesity as compared with the NBW group (adjusted ORs 2.582 and 2.356; 95% CIs 1.413 to 3.579 and 1.097 to 2.934, boys and girls, respectively). According to different educational stages, HBW was positively associated with an increased risk of overweight/obesity compared with the NBW group. The adjusted ORs of the three groups were 2.757 (95% CI 1.483 to 3.658), 2.317 (95% CI 1.451 to 2.795) and 2.216 (95% CI 1.532 to 2.873), respectively. In addition, we found the HBW group with insufficient physical activity time had significantly higher risk of overweight/obesity (OR 2.165, 95% CI 1.352 to 3.378) in the overall population. As expected, a significant additive interaction was found between birth weight and insufficient physical activity time (RERI 2.289, 95% CI 0.678 to 3.576; AP 0.723, 95% CI 0.521 to 1.126). CONCLUSIONS HBW was significantly associated with an increased risk of overweight/obesity in school-aged children and adolescents, and the associations differed by gender-specific and educational stage-specific factors. Notably, HBW possibly interplayed synergistically with insufficient physical activity time to increase the risk of overweight/obesity across gender and educational stages.
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Affiliation(s)
- Yiran Wang
- Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Shuying Luo
- Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | | | - Yaodong Zhang
- Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
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Deng J, Ji W, Liu H, Li L, Wang Z, Hu Y, Wang Y, Zhou Y. Development and validation of a machine learning-based framework for assessing metabolic-associated fatty liver disease risk. BMC Public Health 2024; 24:2545. [PMID: 39294603 PMCID: PMC11412026 DOI: 10.1186/s12889-024-19882-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 08/26/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND The existing predictive models for metabolic-associated fatty liver disease (MAFLD) possess certain limitations that render them unsuitable for extensive population-wide screening. This study is founded upon population health examination data and employs a comparison of eight distinct machine learning (ML) algorithms to construct the optimal screening model for identifying high-risk individuals with MAFLD in China. METHODS We collected physical examination data from 5,171,392 adults residing in the northwestern region of China, during the year 2021. Feature selection was conducted through the utilization of the Least Absolute Shrinkage and Selection Operator (LASSO) regression. Additionally, class balancing parameters were incorporated into the models, accompanied by hyperparameter tuning, to effectively address the challenges posed by imbalanced datasets. This study encompassed the development of both tree-based ML models (including Classification and Regression Trees, Random Forest, Adaptive Boosting, Light Gradient Boosting Machine, Extreme Gradient Boosting, and Categorical Boosting) and alternative ML models (specifically, k-Nearest Neighbors and Artificial Neural Network) for the purpose of identifying individuals with MAFLD. Furthermore, we visualized the importance scores of each feature on the selected model. RESULTS The average age (standard deviation) of the 5,171,392 participants was 51.12 (15.00) years, with 52.47% of the participants being females. MAFLD was diagnosed by specialized physicians. 20 variables were finally included for analyses after LASSO regression model. Following ten rounds of cross-validation and parameter optimization for each algorithm, the CatBoost algorithm exhibited the best performance, achieving an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.862. The ranking of feature importance indicates that age, BMI, triglyceride, fasting plasma glucose, waist circumference, occupation, high density lipoprotein cholesterol, low density lipoprotein cholesterol, total cholesterol, systolic blood pressure, diastolic blood pressure, ethnicity and cardiovascular diseases are the top 13 crucial factors for MAFLD screening. CONCLUSION This study utilized a large-scale, multi-ethnic physical examination data from the northwestern region of China to establish a more accurate and effective MAFLD risk screening model, offering a new perspective for the prediction and prevention of MAFLD.
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Affiliation(s)
- Jiale Deng
- Zhongshan School of Medicine, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, Guangdong, China
| | - Weidong Ji
- Zhongshan School of Medicine, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, Guangdong, China
| | - Hongze Liu
- Zhongshan School of Medicine, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, Guangdong, China
| | - Lin Li
- Zhongshan School of Medicine, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, Guangdong, China
| | - Zhe Wang
- Zhongshan School of Medicine, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, Guangdong, China
| | - Yurong Hu
- School of Computer Science, China University of Geosciences, Wuhan, Beihe, 430074, China
| | - Yushan Wang
- People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Urumqi, 830054, Xinjiang, China.
| | - Yi Zhou
- Zhongshan School of Medicine, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, Guangdong, China.
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Hassanipour S, Amini-Salehi E, Joukar F, Khosousi MJ, Pourtaghi F, Ansar MM, Mahdavi-Roshan M, Heidarzad F, Rashidi-Mojdehi G, Abdzadeh E, Vakilpour A, Mansour-Ghanaei F. The Prevalence of Non-Alcoholic Fatty Liver Disease in Iranian Children and Adult Population: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:1600-1612. [PMID: 37744533 PMCID: PMC10512128 DOI: 10.18502/ijph.v52i8.13399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/11/2023] [Indexed: 09/26/2023]
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is the world's most common etiology of chronic liver disease. In this systematic review and meta-analysis, we estimated the prevalence of NAFLD in the Iranian children and adult population. Methods A comprehensive search of five international databases, including PubMed, ISI/WOS, ProQuest, Scopus, and Google Scholar, was done from inception to Nov 2022. Studies on NAFLD patients and their risk factors were selected for meta-analysis. The quality of the included studies was assessed by The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for cross-sectional, and cohort studies. The heterogeneity between studies was investigated using Cochran test and I2 statistics. Random and fixed effect models were used for heterogenic and non-heterogenic studies, respectively. We used Comprehensive Meta-Analysis version 3 for conducting meta-analysis. Results Twenty studies were finally included. The total prevalence of NAFLD in children, boys, and girls was 6.7% (95% CI: 0.02-0.18), 12.5% (95% CI: 0.04-0.29) and, 10.1% (95% CI: 0.04-0.21), respectively. The total prevalence of NAFLD in obese children, obese boys, and obese girls was 42% (95% CI: 0.18-0.69), 44% (95% CI: 0.13-0.80), and 33 % (95% CI: 0.13-0.62), respectively. The total prevalence of NAFLD in adults was 36.9% (95% CI: 0.31-0.42). The prevalence of NAFLD in men and women was 33.8% (95% CI: 0.27-0.41) and 29.9% (95% CI: 0.21-0.40), respectively. Conclusion NAFLD prevalence in Iranian adults and obese children is considerable; however, data about the children population was insufficient.
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Affiliation(s)
- Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Amini-Salehi
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad-Javad Khosousi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farideh Pourtaghi
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malek Moein Ansar
- Department of Biochemistry, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Marjan Mahdavi-Roshan
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Forough Heidarzad
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Golnaz Rashidi-Mojdehi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Elham Abdzadeh
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Azin Vakilpour
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Imanzadeh F, Olang B, Sayyari AA, Dara N, Khatami K, Hosseini A, Kazemi Aghdam M, Khalili M, Hajipour M, Fazeli Farsan Z, Imanzadeh N, Yaraghi A, Hatami T, Mohammadi S. Prevalence and Related Factors for Non-alcoholic Fatty Liver Disease in Obese Students. JOURNAL OF COMPREHENSIVE PEDIATRICS 2023; 14. [DOI: 10.5812/compreped-135095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/08/2023] [Accepted: 04/14/2023] [Indexed: 01/03/2025]
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) occurs with the pathological accumulation of fat in the liver and is one of the most common liver disorders worldwide among adults and even children. Obesity is a risk factor for NAFLD. Objectives: Considering the increasing prevalence of obesity in Iran and worldwide, this study was conducted to determine the prevalence of NAFLD and its related factors in overweight and obese students of schools in Tehran, Iran. Methods: This cross-sectional study was performed on 115 overweight and obese students [body mass index (BMI) ≥ 25] with an age range of 7 - 17 years. Eligible individuals were classified into two groups with and without NAFLD. Liver ultrasonography and measurement of serum parameters, including fasting blood sugar, lipid profile, and liver enzymes, were performed. Next, the demographic and anthropometric characteristics were compared between the two groups. Results: Out of 115 studied students, 71 subjects were boys (61.7%). The results showed that the mean BMI in patients with fatty liver was significantly higher than in individuals without fatty liver (P = 0.03). According to our findings, the mean total cholesterol in NAFLD patients was significantly higher than in the group without NAFLD (P = 0.008). The univariate logistic regression model results for measuring factors related to fatty liver in students showed a significant positive correlation between male gender, BMI, total cholesterol, aspartate aminotransferase, and alanine aminotransferase. Conclusions: NAFLD is a substantial problem in school children and correlates with elevated BMI. Therefore, the measurement of BMI can be used as a useful predictor and screening tool for NAFLD in school children.
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Dağ H, İncirkuş F, Dikker O. Atherogenic Index of Plasma (AIP) and Its Association with Fatty Liver in Obese Adolescents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:641. [PMID: 37189890 PMCID: PMC10136544 DOI: 10.3390/children10040641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND The atherogenic index of plasma (AIP) is the base-10 logarithmic conversion of the triglyceride to high-density lipoprotein cholesterol ratio [AIP = log10 (triglyceride/HDL cholesterol)]. Some studies have found a link between low serum vitamin D levels, AIP, and fatty liver. This study was conducted to evaluate the relationship between AIP levels, fatty liver, and vitamin D levels in obese adolescents aged 10-17 years. METHODS This study included 136 adolescents, including 83 obese and 53 healthy controls, in the age range of 10-17 years. Thirty-nine of the obese adolescents had fatty livers. Those with ultrasonography grades 2 or 3 of fat were in the fatty liver group. The AIP value was calculated as the logarithmic conversion of the ratio (triglyceride/HDL cholesterol) at the base of 10. Vitamin D and other laboratory tests were analyzed biochemically. Statistical evaluations were made with the SPSS program. RESULTS The AIP, body mass index (BMI), homeostatic model assessment for insulin resistance (HOMA-IR), and insulin averages of obese adolescents with fatty liver were significantly higher than those of obese adolescents without fatty liver and the healthy control group (p < 0.05). Again, the mean AIP of obese patients without fatty liver was pointedly higher than that of the healthy control group (p < 0.05). There was a positive, moderate relationship between AIP and BMI, AIP and HOMA-IR, and AIP and insulin levels (p < 0.05), whereas there was a negative, moderate (37.3%) relationship between AIP and vitamin D (p = 0.019). CONCLUSION AIP levels were higher in obese adolescents, and this increase was higher in obese adolescents with fatty liver in this study. Moreover, we detected a negative correlation between AIP and vitamin D levels and a positive correlation with BMI, insulin resistance, and insulin levels. Based on our data, we concluded that AIP can be a useful predictor of fatty liver in obese adolescents.
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Affiliation(s)
- Hüseyin Dağ
- Division of Pediatrics, Istanbul Prof. Dr. Cemil Taşcıoğlu City Hospital, University of Health Sciences, Istanbul 34384, Turkey
| | - Fatih İncirkuş
- Division of Medical Biochemistry, Istanbul Prof. Dr. Cemil Taşcıoğlu City Hospital, University of Health Sciences, Istanbul 34384, Turkey
| | - Okan Dikker
- Division of Medical Biochemistry, Istanbul Prof. Dr. Cemil Taşcıoğlu City Hospital, University of Health Sciences, Istanbul 34384, Turkey
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Comparison of Body Composition, Muscle Strength and Cardiometabolic Profile in Children with Prader-Willi Syndrome and Non-Alcoholic Fatty Liver Disease: A Pilot Study. Int J Mol Sci 2022; 23:ijms232315115. [PMID: 36499438 PMCID: PMC9739027 DOI: 10.3390/ijms232315115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Syndromic and non-syndromic obesity conditions in children, such as Prader-Willi syndrome (PWS) and non-alcoholic fatty liver disease (NAFLD), both lower quality of life and increase risk for chronic health complications, which further increase health service utilization and cost. In a pilot observational study, we compared body composition and muscle strength in children aged 7−18 years with either PWS (n = 9), NAFLD (n = 14), or healthy controls (n = 16). Anthropometric and body composition measures (e.g., body weight, circumferences, skinfolds, total/segmental composition, and somatotype), handgrip strength, six minute-walk-test (6MWT), physical activity, and markers of liver and cardiometabolic dysfunction (e.g., ALT, AST, blood pressure, glucose, insulin, and lipid profile) were measured using standard procedures and validated tools. Genotyping was determined for children with PWS. Children with PWS had reduced lean body mass (total/lower limb mass), lower handgrip strength, 6MWT and increased sedentary activity compared to healthy children or those with NAFLD (p < 0.05). Children with PWS, including those of normal body weight, had somatotypes consistent with relative increased adiposity (endomorphic) and reduced skeletal muscle robustness (mesomorphic) when compared to healthy children and those with NAFLD. Somatotype characterizations were independent of serum markers of cardiometabolic dysregulation but were associated with increased prevalence of abnormal systolic and diastolic blood pressure Z-scores (p < 0.05). Reduced lean body mass and endomorphic somatotypes were associated with lower muscle strength/functionality and sedentary lifestyles, particularly in children with PWS. These findings are relevant as early detection of deficits in muscle strength and functionality can ensure effective targeted treatments that optimize physical activity and prevent complications into adulthood.
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Marcinkiewicz K, Horodnicka-Józwa A, Jackowski T, Strączek K, Biczysko-Mokosa A, Walczak M, Petriczko E. Nonalcoholic fatty liver disease in children with obesity- observations from one clinical centre in the Western Pomerania region. Front Endocrinol (Lausanne) 2022; 13:992264. [PMID: 36387906 PMCID: PMC9659621 DOI: 10.3389/fendo.2022.992264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Katarzyna Marcinkiewicz
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
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Oses M, Cadenas‐Sanchez C, Medrano M, Galbete A, Miranda‐Ferrua E, Ruiz JR, Sánchez‐Valverde F, Ortega FB, Cabeza R, Villanueva A, Idoate F, Labayen I. Development of a prediction protocol for the screening of metabolic associated fatty liver disease in children with overweight or obesity. Pediatr Obes 2022; 17:e12917. [PMID: 35394122 PMCID: PMC9541234 DOI: 10.1111/ijpo.12917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The early detection and management of children with metabolic associated fatty liver disease (MAFLD) is challenging. OBJECTIVE To develop a non-invasive and accurate prediction protocol for the identification of MAFLD among children with overweight/obesity candidates to confirmatory diagnosis. METHODS A total of 115 children aged 8-12 years with overweight/obesity, recruited at a primary care, were enrolled in this cross-sectional study. The external validation was performed using a cohort of children with overweight/obesity (N = 46) aged 8.5-14.0 years. MAFLD (≥5.5% hepatic fat) was diagnosed by magnetic resonance imaging (MRI). Fasting blood biochemical parameters were measured, and 25 candidates' single nucleotide polymorphisms (SNPs) were determined. Variables potentially associated with the presence of MAFLD were included in a multivariate logistic regression. RESULTS Children with MAFLD (36%) showed higher plasma triglycerides (TG), insulin, homeostasis model assessment of insulin resistance (HOMA-IR), alanine aminotransferase (ALT), aspartate transaminase (AST), glutamyl-transferase (GGT) and ferritin (p < 0.05). The distribution of the risk-alleles of PPARGrs13081389, PPARGrs1801282, HFErs1800562 and PNLPLA3rs4823173 was significantly different between children with and without MAFLD (p < 0.05). Three biochemical- and/or SNPs-based predictive models were developed, showing strong discriminatory capacity (AUC-ROC: 0.708-0.888) but limited diagnostic performance (sensitivity 67%-82% and specificity 63%-69%). A prediction protocol with elevated sensitivity (72%) and specificity (84%) based on two consecutive steps was developed. The external validation showed similar results: sensitivity of 70% and specificity of 85%. CONCLUSIONS The HEPAKID prediction protocol is an accurate, easy to implant, minimally invasive and low economic cost tool useful for the early identification and management of paediatric MAFLD in primary care.
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Affiliation(s)
- Maddi Oses
- Institute for Sustainability & Food Chain Innovation (ISFOOD)University of NavarraPamplonaSpain,Navarra Institute for Health ResearchIdiSNAPamplonaSpain,Department of Health SciencesPublic University of Navarra, Campus de ArrosadiaPamplonaSpain
| | - Cristina Cadenas‐Sanchez
- Institute for Sustainability & Food Chain Innovation (ISFOOD)University of NavarraPamplonaSpain,Navarra Institute for Health ResearchIdiSNAPamplonaSpain,Department of Health SciencesPublic University of Navarra, Campus de ArrosadiaPamplonaSpain
| | - María Medrano
- Institute for Sustainability & Food Chain Innovation (ISFOOD)University of NavarraPamplonaSpain,Navarra Institute for Health ResearchIdiSNAPamplonaSpain,Department of Health SciencesPublic University of Navarra, Campus de ArrosadiaPamplonaSpain
| | - Arkaitz Galbete
- Navarrabiomed‐Hospital Complex of Navarra and Public University of Navarra IdisNAREDISSECPamplonaSpain
| | - Emiliano Miranda‐Ferrua
- Institute for Sustainability & Food Chain Innovation (ISFOOD)University of NavarraPamplonaSpain,Navarra Institute for Health ResearchIdiSNAPamplonaSpain,Department of Health SciencesPublic University of Navarra, Campus de ArrosadiaPamplonaSpain
| | - Jonatan R. Ruiz
- PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, School of Sports ScienceUniversity of GranadaGranadaSpain,Instituto de Investigación Biosanitariaibs.GranadaGranadaSpain
| | | | - Francisco B. Ortega
- PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, School of Sports ScienceUniversity of GranadaGranadaSpain
| | - Rafael Cabeza
- Department of Electrical, Electronic and Communications Engineering, Institute of smart cities (ISC)Public University of NavarrePamplonaSpain
| | - Arantxa Villanueva
- Navarra Institute for Health ResearchIdiSNAPamplonaSpain,Department of Electrical, Electronic and Communications Engineering, Institute of smart cities (ISC)Public University of NavarrePamplonaSpain
| | - Fernando Idoate
- Department of Health SciencesPublic University of Navarra, Campus de ArrosadiaPamplonaSpain,Department of RadiologyMutua NavarraPamplonaSpain
| | - Idoia Labayen
- Institute for Sustainability & Food Chain Innovation (ISFOOD)University of NavarraPamplonaSpain,Navarra Institute for Health ResearchIdiSNAPamplonaSpain,Department of Health SciencesPublic University of Navarra, Campus de ArrosadiaPamplonaSpain
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Quek SXZ, Tan EXX, Ren YP, Muthiah M, Loo EXL, Tham EH, Siah KTH. Factors early in life associated with hepatic steatosis. World J Hepatol 2022; 14:1235-1247. [PMID: 35978672 PMCID: PMC9258263 DOI: 10.4254/wjh.v14.i6.1235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/01/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The rise in prevalence of non-alcoholic fatty liver disease (NAFLD) mirrors the obesity epidemic. NAFLD is insidious but may gradually progress from simple steatosis to steatohepatitis, fibrosis and cirrhosis and/or hepatocellular carcinoma. Intervention strategies to ameliorate developmental programming of NAFLD may be more efficacious during critical windows of developmental plasticity.
AIM To review the early developmental factors associated with NAFLD.
METHODS Databases MEDLINE via PubMed, and EMBASE and Reference Citation Analysis were searched and relevant publications up to April 30, 2021 were assessed. Original research studies that included risk factors associated with early development of NAFLD in human subjects were included. These factors include: Maternal factors, intrauterine and prenatal factors, post-natal factors, genetic and ethnic predisposition, childhood and adolescence environmental factors. Studies were excluded if they were review articles or animal studies, case reports or conference abstracts, or if NAFLD was not clearly defined and assessed radiologically.
RESULTS Of 1530 citations identified by electronic search, 420 duplicates were removed. Of the 1110 citations screened from title and abstract, 80 articles were included in the final analysis. Genetic polymorphisms such as patatin-like phospholipase domain-containing protein 3 (PNPLA3) and membrane-bound O-acyltransferase domain-containing protein 7 (MBOAT7) were associated with increased risk of NAFLD. Familial factors such as maternal obesogenic environment and parental history of hepatic steatosis was associated with offspring NAFLD. Longer duration of exclusive breastfeeding in infancy was associated with a lower risk of developing NAFLD later in life while metabolic dysfunction and/or obesity in adolescence was associated with increased risk of NAFLD. Studies relating to socioeconomic factors and its association with NAFLD reported confounding results.
CONCLUSION Maternal metabolic dysfunction during pregnancy, being exclusively breastfed for a longer time postnatally, diet and physical activity in childhood and adolescence are potential areas of intervention to decrease risk of NAFLD.
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Affiliation(s)
- Sabrina Xin Zi Quek
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Eunice Xiang-Xuan Tan
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Yi Ping Ren
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Mark Muthiah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Evelyn Xiu Ling Loo
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore 119228, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore
| | - Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore 119228, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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10
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Liu Y, Tan Y, Huang J, Wu C, Fan X, Stalin A, Lu S, Wang H, Zhang J, Zhang F, Wu Z, Li B, Huang Z, Chen M, Cheng G, Mou Y, Wu J. Revealing the Mechanism of Huazhi Rougan Granule in the Treatment of Nonalcoholic Fatty Liver Through Intestinal Flora Based on 16S rRNA, Metagenomic Sequencing and Network Pharmacology. Front Pharmacol 2022; 13:875700. [PMID: 35559233 PMCID: PMC9086680 DOI: 10.3389/fphar.2022.875700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/16/2022] [Indexed: 12/12/2022] Open
Abstract
Background: The incidence of Nonalcoholic Fatty Liver (NAFL) is increasing year by year, growing evidence suggests that the intestinal flora plays a causative role in NAFL. Huazhi Rougan Granule (HRG) is commonly used in the clinical treatment of NAFL. It is reported that it can reduce lipids and protect the liver, but no research has confirmed whether the drug's effect is related to the intestinal flora. Therefore, we investigated whether the effect of HRG is related to the regulation of intestinal flora to further explore the mechanism of HRG in the treatment of NAFL through intestinal flora. Methods: In this study, C57BL/6J mice were fed a high-fat diet for 8 weeks, and the high-fat diet plus HRG or polyene phosphatidylcholine capsules were each administered by gavage for 4 weeks. High-throughput sequencing, network pharmacology, and molecular docking were used to explore the mechanism of HRG in the treatment of NAFL through intestinal flora. Results: HRG treatment can reduce body weight gain, lipid accumulation in liver and lipogenesis and reduce serum biochemical indexes in high-fat-fed mice. Analysis of intestinal flora showed that HRG changed the composition of intestinal flora, which was characterized by a decrease in the Firmicutes/Bacteroidetes ratio. Moreover, the species distribution was significantly correlated with AKP, HDL-C, and TG. Metagenetic analysis showed that HRG altered the functional composition and functional diversity of microorganisms, which was mainly characterized by an increase in the abundance of metabolic pathways. The network pharmacology results show that the mechanism of HRG in the treatment of NAFL through intestinal flora is mainly reflected in the biological process of gene function and related to infectious diseases, immune systems, and signal transduction pathways, such as cytokine-cytokine receptor interaction, Chagas disease, IL-17 signaling pathway and other signaling pathways. Conclusion: These results strongly suggest that HRG may alleviate NAFL by preventing IFD.
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Affiliation(s)
- Yingying Liu
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Yingying Tan
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Jiaqi Huang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Chao Wu
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaotian Fan
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Antony Stalin
- Institute of Fundamental and Frontier Sciences, University of Electronic Science and Technology of China, Chengdu, China
| | - Shan Lu
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Haojia Wang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Jingyuan Zhang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Fanqin Zhang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Zhishan Wu
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Bing Li
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Linyi, China
| | - Zhihong Huang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Meilin Chen
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Guoliang Cheng
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Linyi, China
| | - Yanfang Mou
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Linyi, China
| | - Jiarui Wu
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
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11
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Ramírez-Vélez R, García-Hermoso A, Correa-Rodríguez M, Izquierdo M. Defining values for controlled attenuation parameter and liver stiffness in youth without liver disease. Pediatr Res 2022; 91:912-920. [PMID: 33846557 DOI: 10.1038/s41390-021-01441-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND We aimed to determine the reference values to define an age-specific normal range of controlled attenuation parameter (CAP, a measure of liver steatosis) and liver stiffness measurement (LSM) values assessed by ultrasound-based transient elastography in adolescents without underlying liver disease. METHODS A total of 462 participants were included in this cross-sectional study using data from NHANES 2017-2018. LSM and CAP were carried out using the FibroScan® M-probe. Anthropometric, metabolic and hematological parameters were measured. RESULTS The median CAP was 199.0 dB/m (150.0-245.0 dB/m, 10th to 90th percentiles) and the median LSM was 4.7 kPa (3.4-6.3 kPa, 10th to 90th percentiles) for ages 12-19.9 years. Regression analyses show that the CAP and LSM were not positively correlated with age (boys CAP R2 = 0.001, p = 0.576 and LSM R2 = 0.012, p = 0.096; girls CAP R2 = 0.011, p = 0.113 and LSM R2 = 0.006, p = 0.236). Finally, CAP was positively associated with LSM in girls (β = 0.189, p = 0.005) but not in boys (β = -0.083, p = 0.202). CONCLUSIONS The reference values indicated here for LSM and CAP will help in the screening of adolescents between ages 12 and 19.9 years and might serve as a useful method for identifying those youth at high risk of nonalcoholic fatty liver disease. IMPACT The reference values indicated in this study for liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) will help in the screening of adolescents between ages 12 and 19.9 years in clinical practice. The cutoffs of LSM and CAP might serve as a useful method for identifying those youth at high risk of nonalcoholic fatty liver disease.
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Affiliation(s)
- Robinson Ramírez-Vélez
- Department of Health Sciences, Public University of Navarra, Navarrabiomed-IdiSNA, Complejo Hospitalario de Navarra (CHN), Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio García-Hermoso
- Department of Health Sciences, Public University of Navarra, Navarrabiomed-IdiSNA, Complejo Hospitalario de Navarra (CHN), Pamplona, Spain.,Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Santiago, Chile
| | - María Correa-Rodríguez
- Instituto de Investigación Biosanitaria Granada (IBIS Granada), Granada, Spain. .,Department of Nursing, Faculty of Health Sciences, University of Granada (UGR), Granada, Spain.
| | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarra, Navarrabiomed-IdiSNA, Complejo Hospitalario de Navarra (CHN), Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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12
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Lazarus JV, Mark HE, Anstee QM, Arab JP, Batterham RL, Castera L, Cortez-Pinto H, Crespo J, Cusi K, Dirac MA, Francque S, George J, Hagström H, Huang TTK, Ismail MH, Kautz A, Sarin SK, Loomba R, Miller V, Newsome PN, Ninburg M, Ocama P, Ratziu V, Rinella M, Romero D, Romero-Gómez M, Schattenberg JM, Tsochatzis EA, Valenti L, Wong VWS, Yilmaz Y, Younossi ZM, Zelber-Sagi S. Advancing the global public health agenda for NAFLD: a consensus statement. Nat Rev Gastroenterol Hepatol 2022; 19:60-78. [PMID: 34707258 DOI: 10.1038/s41575-021-00523-4] [Citation(s) in RCA: 433] [Impact Index Per Article: 144.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 12/11/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a potentially serious liver disease that affects approximately one-quarter of the global adult population, causing a substantial burden of ill health with wide-ranging social and economic implications. It is a multisystem disease and is considered the hepatic component of metabolic syndrome. Unlike other highly prevalent conditions, NAFLD has received little attention from the global public health community. Health system and public health responses to NAFLD have been weak and fragmented, and, despite its pervasiveness, NAFLD is largely unknown outside hepatology and gastroenterology. There is only a nascent global public health movement addressing NAFLD, and the disease is absent from nearly all national and international strategies and policies for non-communicable diseases, including obesity. In this global Delphi study, a multidisciplinary group of experts developed consensus statements and recommendations, which a larger group of collaborators reviewed over three rounds until consensus was achieved. The resulting consensus statements and recommendations address a broad range of topics - from epidemiology, awareness, care and treatment to public health policies and leadership - that have general relevance for policy-makers, health-care practitioners, civil society groups, research institutions and affected populations. These recommendations should provide a strong foundation for a comprehensive public health response to NAFLD.
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Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
- EASL International Liver Foundation, Geneva, Switzerland.
| | - Henry E Mark
- EASL International Liver Foundation, Geneva, Switzerland
| | - Quentin M Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Juan Pablo Arab
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Rachel L Batterham
- Centre for Obesity Research, University College London and National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Laurent Castera
- Department of Hepatology, Hôpital Beaujon, Université de Paris, Paris, France
| | - Helena Cortez-Pinto
- Clínica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Javier Crespo
- Gastroenterology and Heptology Unit, Hospital Universitario Marqués de Valdecilla, Santander, IDIVAL, Santander, Spain
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Veterans Health Administration and University of Florida, Gainesville, FL, USA
| | - M Ashworth Dirac
- Department of Health Metrics Sciences, Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Sven Francque
- Department of Gastroenterology Hepatology, University Hospital Antwerp, Antwerp, Belgium
- Translational Sciences in Inflammation and Immunology TWI2N, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Hannes Hagström
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Terry T-K Huang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Mona H Ismail
- Division of Gastroenterology, Department of Internal Medicine, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rohit Loomba
- Department of Medicine, NAFLD Research Center, La Jolla, CA, USA
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Veronica Miller
- University of California Berkeley, School of Public Health, Forum for Collaborative Research, Washington, DC, USA
| | - Philip N Newsome
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
| | | | - Ponsiano Ocama
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Vlad Ratziu
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitie-Salpetriere, University of Paris, Paris, France
| | - Mary Rinella
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Diana Romero
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Manuel Romero-Gómez
- UCM Digestive Diseases, CIBEREHD and IBIS, Virgen del Rocío University Hospital, University of Seville, Seville, Spain
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre Mainz, Mainz, Germany
| | - Emmanuel A Tsochatzis
- University College London Institute for Liver and Digestive Health, Royal Free Hospital, London, UK
- Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Precision Medicine, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yusuf Yilmaz
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
- Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey
| | | | - Shira Zelber-Sagi
- University of Haifa, Faculty of Social Welfare and Health Sciences, School of Public Health, Mount Carmel, Haifa, Israel
- Department of Gastroenterology, Tel-Aviv Medical Centre, Tel-Aviv, Israel
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13
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Lee LW, Yen JB, Lu HK, Liao YS. Prediction of Nonalcoholic Fatty Liver Disease by Anthropometric Indices and Bioelectrical Impedance Analysis in Children. Child Obes 2021; 17:551-558. [PMID: 34265208 DOI: 10.1089/chi.2021.0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in children and is associated with obesity. Objectives: To test whether addition of bioelectrical impedance analysis (BIA) parameters to BMI and anthropometric indices improves the prediction performance of NAFLD than BMI z score (BAZ) alone. Methods: This cross-sectional study recruited 933 children 6-12 years of age for anthropometric measure, BIA, and liver ultrasound. Prediction models of the BAZ, anthropometric, and BIA sets were built in children with obesity using machine learning algorithms. Results: Prevalences of NAFLD were 44.4% (59/133) and 20% (12/60) in boys and girls with obesity, respectively. In both sexes, BAZ set performed worst; adding anthropometric indices into the model improved the model performance, whereas BIA parameters were the best approach for predicting NAFLD. The best result in boys achieved had an accuracy of 75.9% and area under receiver operating characteristic curve of 0.854. In girls, the best result achieved had an F-measure score of 0.615, Matthews correlation coefficient of 0.512, and area under precision-recalled curve of 0.697. Conclusion: BIA is a simple and highly precise tool that yields better NAFLD prediction model than anthropometric indices, and much better performance than BAZ. This study suggests BIA as a potential predictor for pediatric NAFLD.
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Affiliation(s)
- Li-Wen Lee
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Ju-Bei Yen
- Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Hsueh-Kuan Lu
- General Education Center, National Taiwan University of Sport, Taichung, Taiwan
| | - Yu-San Liao
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Yunlin, Taiwan
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14
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Sweeny KF, Lee CK. Nonalcoholic Fatty Liver Disease in Children. Gastroenterol Hepatol (N Y) 2021; 17:579-587. [PMID: 35465068 PMCID: PMC9021174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. It represents a spectrum of disease from simple hepatic steatosis to steatohepatitis that may develop into progressive hepatic fibrosis and even cirrhosis. NAFLD is the most rapidly increasing indication for liver transplantation in adults. In children, the incidence of NAFLD has also increased over the past decade. Although the majority of children with NAFLD are overweight or obese, there is an increasing subset of children with normal body mass index with so-called lean NAFLD. NAFLD in children is associated with several extrahepatic manifestations, including hyperlipidemia, insulin resistance, and obstructive sleep apnea. The pathogenesis of NAFLD in children involves a multifactorial interaction among genetics, in utero exposures, early childhood exposures, and ongoing nutritional exposures. Although there are some similarities between pediatric NAFLD and adult NAFLD, liver biopsies in children show histologic differences between the two. The current standard-of-care treatment of NAFLD in children is lifestyle change to decrease caloric intake and increase physical activity. There are no medications currently approved for the treatment of NAFLD in children. This article aims to summarize the current understanding of pediatric NAFLD and future directions for intervention and therapeutic aims.
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Affiliation(s)
- Katherine F. Sweeny
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Christine K. Lee
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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15
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Alsuhaibani KA, Althunayyan FS, Alsudays AM, Alharbi AA, Aljarallah BM. Nonalcoholic fatty liver disease in lean and obese patients in Saudi patients from a single center. J Family Med Prim Care 2021; 10:3381-3386. [PMID: 34760761 PMCID: PMC8565117 DOI: 10.4103/jfmpc.jfmpc_185_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/15/2021] [Accepted: 03/25/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Fatty liver is a disease caused by the accumulation of fat in the liver. It is one of the major risk factors for developing cirrhosis and hepatocellular carcinoma. Saudi Arabia is one of the most prevalent countries in diabetes and obesity; the overall prevalence of diabetes is 23.7% and obesity is 35.6%. Aim: To study the correlation between fatty liver finding on abdominal ultrasound (US) and their clinical and biochemical profile including BMI, blood glucose level, lipid profile, liver function tests, and blood pressure in both group lean and obese patients. Methods: Cross-sectional study of 346 fatty liver ultrasound-proven patients were enrolled in the study from January to May 2016 in King Saud Hospital- Qassim, Saudi Arabia. Results: Mean age of the participants was 50.3 years. Female participants were 55% of the cohort. Participants were divided based on their BMI: BMI <25 (lean), BMI of 25–30 (overweight and mild obesity), and BMI >30 (morbid obesity). We found that cholesterol (P = 0.007) and low-density lipoprotein (LDL) (P = 0.015) were higher in lean compared to others (5 and 3.1), respectively. Gamma-glutamyl transferase (GGT) was higher in mildly obese patients (113.2) and ALT, which was higher in lean patients (60.4). In addition, 34.5% of the overall patients had Diabetes Mellitus (DM). We found that HbA1c was lower in lean (7.3) compared to morbidly obese patients (7.6). Platelets counts were higher in morbidly obese patients (278) compared to other groups. Conclusion: High cholesterol and LDL strongly correlated with lean fatty liver patients. There was a significant relationship between the female gender and the risk of development of fatty liver. However, liver enzymes were within the normal range, except GGT, which was higher in all the groups, with the highest value in mildly obese patients. Therefore, they are not sensitive for diagnosing fatty liver patients.
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Affiliation(s)
- Khalid A Alsuhaibani
- Medical Imaging Department, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Faris S Althunayyan
- Department of Paediatrics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ali M Alsudays
- Department of Otolaryngology Head and Neck Surgery Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahmad A Alharbi
- Department of Internal Medicine, King Saud Hospital, Qassim, Saudi Arabia
| | - Badr M Aljarallah
- Department of Internal Medicine, College of Medicine, Qassim University, Saudi Arabia
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16
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Moran-Lev H, Cohen S, Webb M, Yerushalmy-Feler A, Amir A, Gal DL, Lubetzky R. Higher BMI predicts liver fibrosis among obese children and adolescents with NAFLD - an interventional pilot study. BMC Pediatr 2021; 21:385. [PMID: 34479517 PMCID: PMC8414665 DOI: 10.1186/s12887-021-02839-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 08/16/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) can range from simple steatosis to steatohepatitis with or without fibrosis. The predictors for liver fibrosis and the effect of nutritional intervention on hepatic fibrosis in pediatric population are not well established. We aimed to investigate the predictors for liver fibrosis and the effects of short-term nutritional intervention on steatosis and fibrosis among obese adolescents with NAFLD. METHODS Cross-sectional study among obese adolescents. Sociodemographic and clinical data were collected. Liver fibrosis was estimated by Shearwave elastography. All participants were recommended to consume a low carbohydrate diet and were followed biweekly. Blood tests and elastography were performed upon admission and repeated after 3 months. RESULTS Fifty-seven pediatric patients were recruited (35 males, mean age 13.5±2.9 years, mean body mass index [BMI] 38.8±9.7). Liver fibrosis was diagnosed in 34 (60%) subjects, which was moderate/severe (F≥2) in 24 (70%). A higher BMI Z score and moderate/severe steatosis correlated with moderate/severe fibrosis (P < 0.05). Seventeen patients completed 3 months of follow-up and displayed a decrease in BMI Z score (from BMI Z score 2.6±0.5 before intervention to 2.4±0.5 after intervention), with a significant decrease in liver fibrosis (P = 0.001). CONCLUSION Pediatric patients with high BMIs and severe liver steatosis are at risk for severe liver fibrosis. Nutritional intervention with minimal weight loss may improves hepatic fibrosis among the pediatric population. TRIAL REGISTRATION TRN NCT04561804 (9/17/2020).
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Affiliation(s)
- Hadar Moran-Lev
- Department of Pediatrics, Dana Dwek Children`s Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Pediatric Gastroenterology Unit, Dana Dwek Children's Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shlomi Cohen
- Pediatric Gastroenterology Unit, Dana Dwek Children's Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Muriel Webb
- Department of Gastroenterology, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Yerushalmy-Feler
- Pediatric Gastroenterology Unit, Dana Dwek Children's Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Achiya Amir
- Pediatric Gastroenterology Unit, Dana Dwek Children's Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana L Gal
- Pediatric Gastroenterology Unit, Dana Dwek Children's Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Lubetzky
- Department of Pediatrics, Dana Dwek Children`s Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Rohner M, Heiz R, Feldhaus S, Bornstein SR. Hepatic-Metabolite-Based Intermittent Fasting Enables a Sustained Reduction in Insulin Resistance in Type 2 Diabetes and Metabolic Syndrome. Horm Metab Res 2021; 53:529-540. [PMID: 34192792 PMCID: PMC8360708 DOI: 10.1055/a-1510-8896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/12/2021] [Indexed: 11/03/2022]
Abstract
Insulin resistance is the hallmark of Type 2 Diabetes and is still an unmet medical need. Insulin resistance lies at the crossroads of non-alcoholic fatty liver disease, obesity, weight loss and exercise resistance, heart disease, stroke, depression, and brain health. Insulin resistance is purely nutrition related, with a typical molecular disease food intake pattern. The insulin resistant state is accessible by TyG as the appropriate surrogate marker, which is found to lead the personalized molecular hepatic nutrition system for highly efficient insulin resistance remission. Treating insulin resistance with a molecular nutrition-centered approach shifts the treatment paradigm of Type 2 Diabetes from management to cure. This allows remission within five months, with a high efficiency rate of 85%. With molecular intermittent fasting a very efficient treatment for prediabetes and metabolic syndrome is possible, improving the non-alcoholic fatty liver disease (NAFL) state and enabling the body to lose weight in a sustainable manner.
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Affiliation(s)
| | - Robert Heiz
- Zentrum für Komplementärmedizin AG, Uster,
Switzerland
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18
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Putri RR, Casswall T, Hagman E. Prevalence of increased transaminases and its association with sex, age, and metabolic parameters in children and adolescents with obesity - a nationwide cross-sectional cohort study. BMC Pediatr 2021; 21:271. [PMID: 34107897 PMCID: PMC8188660 DOI: 10.1186/s12887-021-02747-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/28/2021] [Indexed: 01/18/2023] Open
Abstract
Background Childhood obesity increases the risk of non-alcoholic fatty liver disease marked by elevated alanine aminotransferase (ALT). This study investigated the prevalence of increased ALT in children and adolescents with obesity, and its associations with sex, age, degree of obesity, and metabolic parameters. Methods Individuals between 5 and 17.99 years of age enrolled in the Swedish Childhood Obesity Treatment Register (BORIS) before March 2020 were included. Mildly increased ALT was defined by ALT 27–51 U/L (males) and 23–43 U/L (females), while markedly increased ALT by levels above. Multiple logistic regression models were used for statistical analysis. Results Among 11,776 individuals (age 11.0 ± 3.3 years, 53.5% males), the prevalence of mildly and markedly increased ALT were 37.9 and 10.6%, respectively. A sex-age interaction was found, where increasing age strengthened the odds of markedly increased ALT in males (OR, 99% CI: 1.34, 1.29–1.4 for each year) while the corresponding pattern in females with was minuscule (1.09, 1.02–1.10). Compared to class I obesity, class II and III obesity had greater odds ratios for mildly increased ALT (class II obesity OR, 99% CI: 1.51, 1.35–1.70; class III obesity OR, 99% CI: 2.17, 1.66–2.61) and for markedly increased ALT (class II obesity OR, 99% CI: 1.82, 1.51–2.20; class III obesity OR, 99% CI 3.38, 2.71–4.23). Dyslipidemia was associated with both mildly and markedly increased ALT, all p < 0.001. Prevalence of impaired fasting glucose was 19.1% in normal ALT group, 20.4% in mildly increased ALT group, and 29.0% in markedly increased ALT group. Conclusions The risk of markedly increased ALT increased exponentially with age among boys, but not among girls. Higher degree of obesity was observed in individuals with mildly and markedly increased ALT. Further, metabolic derangements were more prevalent among individuals with mildly and markedly increased ALT.
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Affiliation(s)
- Resthie R Putri
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Blickagången 6A, 141 57 Huddinge, Stockholm, Sweden
| | - Thomas Casswall
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Blickagången 6A, 141 57 Huddinge, Stockholm, Sweden
| | - Emilia Hagman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Blickagången 6A, 141 57 Huddinge, Stockholm, Sweden.
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Ramírez-Vélez R, González-Ruíz K, González-Jiménez E, Schmidt-RioValle J, Correa-Rodríguez M, García-Hermoso A, Palomino-Echeverría S, Izquierdo M. Serum leptin as a mediator of the influence of insulin resistance on hepatic steatosis in youths with excess adiposity. Nutr Metab Cardiovasc Dis 2021; 31:1308-1316. [PMID: 33618924 DOI: 10.1016/j.numecd.2020.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS The relationship between insulin resistance (IR) and hepatic steatosis (fatty liver) is well known; however, the extent to which the satiety hormone leptin acts as a confounder or mediator in this relationship is uncertain. We examined whether the association between IR and hepatic steatosis is mediated by leptin in Colombian adolescents with excess adiposity. METHODS AND RESULTS A total of 122 adolescents (mean age: 13.4 years; 68% girls) participated in the study. We assessed body composition, hepatic steatosis (as defined by the controlled attenuation parameter [CAP]), cardiometabolic risk factors (body mass index, waist circumference, body composition), biochemical variables (leptin, insulin, glucose, lipid profile, cardiometabolic Z-score, transaminases, etc.), and physical fitness (cardiorespiratory fitness and grip strength). Partial correlation, regression, and mediation analyses were conducted using the Barron and Kenny framework. RESULTS Ninety-two youths (75.4%) had IR. Mediation analysis revealed a positive relationship between Homeostasis Model Assessment-IR (HOMA-IR) and CAP (βdir = 3.414, 95% confidence interval [CI]: 1.012 to 5.816, p < 0.001), which was attenuated when leptin was included in the model, thus indicating that leptin mediates this relationship (βind = 1.074, 95% CI: 0.349 to 2.686, p < 0.001). The percentage of the total effect mediated by leptin was 21%. Regarding sex, the mediation effect of leptin remains significant among boys (βind = 0.962, 95% CI: 0.009 to 2.615, p < 0.001), but not in girls (βind = 0.991, 95% CI: 1.263 to 5.483, p = 0.477). CONCLUSIONS The findings are clinically relevant to consider leptin levels as a surrogate marker of insulin sensitivity when assessing youths with excess adiposity and/or suspected Nonalcoholic hepatic steatosis or nonalcoholic fatty liver disease (NAFLD).
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Affiliation(s)
- Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IDISNA, 31008, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Institute of Health Carlos III, Madrid, Spain.
| | - Katherine González-Ruíz
- Physical Exercise and Sports Research Group, Vice Chancellor for Research, Manuela Beltrán University (UMB), Bogotá, DC, 110231, Colombia.
| | - Emilio González-Jiménez
- Department of Nursing, Health Sciences Faculty, University of Granada, Avda. De la Ilustración 60, 18016, Granada, Spain.
| | - Jacqueline Schmidt-RioValle
- Department of Nursing, Health Sciences Faculty, University of Granada, Avda. De la Ilustración 60, 18016, Granada, Spain.
| | - María Correa-Rodríguez
- Department of Nursing, Health Sciences Faculty, University of Granada, Avda. De la Ilustración 60, 18016, Granada, Spain.
| | - Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IDISNA, 31008, Pamplona, Spain; Physical Activity, Sport and Health Sciences Laboratory, University of Santiago de Chile (USACH), Santiago de Chile, 7500618, Chile.
| | - Sara Palomino-Echeverría
- Translational Bioinformatics Unit (TransBio), Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IDISNA, 31008, Pamplona, Spain.
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IDISNA, 31008, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Institute of Health Carlos III, Madrid, Spain.
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20
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Suri A, Song E, van Nispen J, Voigt M, Armstrong A, Murali V, Jain A. Advances in the Epidemiology, Diagnosis, and Management of Pediatric Fatty Liver Disease. Clin Ther 2021; 43:438-454. [PMID: 33597074 DOI: 10.1016/j.clinthera.2021.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Nonalcoholic fatty liver (NAFL) is a major contributor to pediatric liver disease. This review evaluated the current literature on prevalence, screening, diagnosis, and management of NAFL in children and explored recent advances in the field of pediatric NAFL. METHODS A PubMed search was performed for manuscripts describing disease burden, diagnosis, and management strategies in pediatric NAFL published within the past 15 years. Systematic reviews, clinical practice guidelines, randomized controlled trials, and cohort and case-control studies were reviewed for the purpose of this article. FINDINGS The prevalence of NAFL in children is increasing. It is a leading cause of liver-related morbidity and mortality in children. Screening and diagnosis of NAFL in children are a challenge. Lifestyle changes and exercise are the cornerstones of the management of NAFL. IMPLICATIONS Further research is needed to develop better screening and diagnostic tools for pediatric NAFL, including noninvasive diagnostics. NAFL therapeutics is another area of much-needed, ongoing research.
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Affiliation(s)
- Anandini Suri
- Department of Pediatrics, School of Medicine, St. Louis University, St. Louis, Missouri, USA.
| | - Eric Song
- Department of Pediatrics, School of Medicine, St. Louis University, St. Louis, Missouri, USA
| | - Johan van Nispen
- Department of Pediatrics, School of Medicine, St. Louis University, St. Louis, Missouri, USA
| | - Marcus Voigt
- Department of Pediatrics, School of Medicine, St. Louis University, St. Louis, Missouri, USA
| | - Austin Armstrong
- Department of Pediatrics, School of Medicine, St. Louis University, St. Louis, Missouri, USA
| | - Vidul Murali
- Department of Pediatrics, School of Medicine, St. Louis University, St. Louis, Missouri, USA
| | - Ajay Jain
- Department of Pediatrics, School of Medicine, St. Louis University, St. Louis, Missouri, USA
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Jankowska A, Brzeziński M, Romanowicz-Sołtyszewska A, Szlagatys-Sidorkiewicz A. Metabolic Syndrome in Obese Children-Clinical Prevalence and Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031060. [PMID: 33504076 PMCID: PMC7908375 DOI: 10.3390/ijerph18031060] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/19/2022]
Abstract
The prevalence of childhood obesity is increasing worldwide. Some obese children can go on to develop metabolic syndrome (MetS), but exactly who among them remains to be determined. The aim of this study was to indicate predisposing factors for metabolic syndrome, especially those that can be modified. The study comprised 591 obese children aged 10–12 years. They were all Caucasian residents of Gdańsk, Poland, with similar demographic backgrounds. Clinical examination, anthropometry, biometric impedance analysis, blood tests (including oral glucose tolerance tests (OGTT) and insulinemia), and dietary and physical activity evaluation were conducted. The results of our study show that the risk factors for MetS or any of its components include male sex, parental (especially paternal) obesity, low body mass at birth, as well as omitting breakfast or dinner. There are few risk factors for metabolic syndrome both in obese adults and children. Some of these predictors can be modified, especially those in relation to lifestyle. Identifying and then influencing these factors may help to reduce the development of metabolic syndrome and consequently improve health and quality of life.
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Affiliation(s)
- Agnieszka Jankowska
- Department of Paediatrics, Gastroenterology, Allergology and Paediatric Nutrition, Medical University of Gdańsk, 80-462 Gdańsk, Poland; (M.B.); (A.S.-S.)
- Correspondence: ; Tel.: +48-764-0468
| | - Michał Brzeziński
- Department of Paediatrics, Gastroenterology, Allergology and Paediatric Nutrition, Medical University of Gdańsk, 80-462 Gdańsk, Poland; (M.B.); (A.S.-S.)
| | | | - Agnieszka Szlagatys-Sidorkiewicz
- Department of Paediatrics, Gastroenterology, Allergology and Paediatric Nutrition, Medical University of Gdańsk, 80-462 Gdańsk, Poland; (M.B.); (A.S.-S.)
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Novel markers in predicting non-alcoholic liver fatty and metabolic syndrome in obese children and adolescents: Atherogenic index of plasma and monocyte / high-density lipoprotein cholesterol ratio. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.812679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Gupta N, Jindal G, Nadda A, Bansal S, Gahukar S, Kumar A. Prevalence and risk factors for nonalcoholic fatty liver disease in obese children in rural Punjab, India. J Family Community Med 2020; 27:103-108. [PMID: 32831555 PMCID: PMC7415271 DOI: 10.4103/jfcm.jfcm_287_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Pediatric nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance, hypertension, metabolic syndrome, cardiovascular problems, and increased risk of chronic liver disease and Type II diabetes mellitus. The aim of the study was to assess the metabolic profiles and associated risk factors of NAFLD in obese children. MATERIALS AND METHODS Children with a body mass index (BMI) of >27 kg/m2 an adult equivalent cutoff (Indian Academy of Paediatrics, 2015 guidelines) aged 5-18 years presenting to the pediatric outpatient unit of PGIMER Satellite Centre, Sangrur, India, were retrospectively recruited over a 1-year period. Anthropometry, lipid profile, thyroid levels, liver function test, fasting blood sugar, and blood pressure were measured. Ultrasonography was used to diagnose NAFLD. Logistic regression was used to assess the risk factors. RESULTS A total of 100 children participated in the study. The mean age was 10.6 ± 2.6 years and the mean BMI-Z score was 2.6 ± 0.5. The prevalence of NAFLD was 62%. Alanine transaminase (ALT) was significantly elevated in all the children with NAFLD. Lipid levels and BMI Z-score were similar in both groups. Unadjusted odds ratio shows statistically significant association of ALT (2.058 [1.11-1.01]) and waist circumference (1.089 [1.19-0.99]) with NAFLD. With adjusted odds ratio only, ALT (1.12 [1.24-1.01]) was found to be significantly associated with NAFLD. CONCLUSION There is quite a high prevalence of nonalcoholic fatty liver in obese Indian children. All children with raised liver enzymes should undergo sonography to rule out NAFLD.
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Affiliation(s)
- Nishu Gupta
- Department of Pediatrics, PGIMER Satellite Centre Sangrur, Patiala, Punjab, India
| | - Gunjan Jindal
- Department of Radiodiagnosis, PGIMER Satellite Centre Sangrur, Patiala, Punjab, India
| | - Anuradha Nadda
- Department of Community Medicine, Gian Sagar Medical College and Hospital, Patiala, Punjab, India
| | - Saloni Bansal
- Department of Biochemistry, PGIMER Satellite Centre Sangrur, Patiala, Punjab, India
| | - Shailesh Gahukar
- Department of Hospital Administration, PGIMER Satellite Centre Sangrur, Patiala, Punjab, India
| | - Ashok Kumar
- Department of Hospital Administration, PGIMER, Chandigarh, India
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Deng JR, Tan WQ, Yang SY, Ao LP, Liang JP, Li LX, Gao YH, Yang Y, Liu L. High birth weight and its interaction with physical activity influence the risk of obesity in early school-aged children. World J Pediatr 2020; 16:385-392. [PMID: 32100262 DOI: 10.1007/s12519-020-00336-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 01/03/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND High birth weight (HBW) is associated with childhood obesity, but with inconsistent results. This study investigated the relationship between HBW and childhood obesity, and further explored the interaction of HBW with behavioral and socio-economic determinants of obesity. METHODS This cross-sectional study enrolled 1906 grade-two children of Guangzhou, China, from June to November, 2016. Overweight/obesity corresponded to a body mass index higher than the sex-age-specific criteria. Abdominal obesity was assessed using the sex-specific waist-height ratio cutoffs. The association of HBW with obesity was evaluated in multivariable logistic regression model. The relative excess risk due to interaction (RERI) and the attributable proportion of interaction (AP) indices were used to measure additive interaction, while applying the interaction of OR index for multiplicative interaction assessment. RESULTS Children with HBW had an increased risk of overweight/obesity [odds ratio (OR) = 2.42, 95% confidence interval (CI) = 1.56-3.76] compared with those without HBW. Significant additive interaction of HBW with physical activity was found for overweight/obesity [relative excess risk due to interaction (RERI) = 2.69, 95% CI = 0.62-4.75; attributable proportion of interaction (AP) = 0.72, 95% CI = 0.42-1.02]. The HBW children with insufficient activity had higher odds of overweight/obesity compared to the non-HBW children with sufficient activity (OR = 3.75, 95% CI = 2.06-6.83). In addition, we identified a significant interaction of HBW with household income for abdominal obesity (RERI = 1.20, 95% CI = 0.02-2.37; AP = 0.76, 95% CI = 0.16-1.36). CONCLUSIONS HBW confers an increased risk for childhood overweight/obesity. Physical activity attenuates the effect of HBW on overweight/obesity, and HBW possibly synergistically interacts with high household income to promote abdominal obesity in childhood.
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Affiliation(s)
- Jia-Ru Deng
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, 283 Jianghai Road, Guangzhou, 510310, China.,Futian Hospital for Prevention and Treatment of Chronic Disease, Shenzhen, 518048, China
| | - Wei-Qing Tan
- Guangzhou Health Care Promotion Center for Primary and Middle Schools, Guangzhou, 510180, China
| | - Shu-Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, 283 Jianghai Road, Guangzhou, 510310, China
| | - Li-Ping Ao
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, 283 Jianghai Road, Guangzhou, 510310, China
| | - Jian-Ping Liang
- Guangzhou Health Care Promotion Center for Primary and Middle Schools, Guangzhou, 510180, China
| | - Li-Xia Li
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, 283 Jianghai Road, Guangzhou, 510310, China
| | - Yan-Hui Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, 283 Jianghai Road, Guangzhou, 510310, China
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, 283 Jianghai Road, Guangzhou, 510310, China
| | - Li Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, 283 Jianghai Road, Guangzhou, 510310, China.
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Tuna T, Espinheira MDC, Vasconcelos C, Preto J, Campos JM. Laparoscopic sleeve gastrectomy in morbidly obese adolescents: Initial experience of a Pediatric Multidisciplinary Unit. Arch Pediatr 2020; 27:310-314. [PMID: 32651142 DOI: 10.1016/j.arcped.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/08/2020] [Accepted: 06/01/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Childhood obesity is a significant health problem worldwide, associated with significant metabolic and cardiovascular morbidity. Recent evidence points to metabolic and bariatric surgery as a safe and effective treatment for morbidly obese adolescents. We aim to report the initial results after laparoscopic sleeve gastrectomy (LSG) for adolescent patients in a pediatric center. MATERIAL AND METHODS Retrospective data review of patients younger than 19 years who underwent LSG for treatment of morbid obesity between 2013 and 2019. RESULTS A total of 16 adolescents (12 female, 4 male) with a median age of 17.5 years underwent LSG. Median preoperative weight and body mass index were 129kg and 48.6kg/m-2, respectively. All patients had at least one comorbidity. Median follow-up was 18.5 months. The overall percent total weight loss was 32.5% and percent excess weight loss was 68%. Resolution of comorbidities was noted in the majority of patients. No perioperative complications were reported. CONCLUSIONS Laparoscopic sleeve gastrectomy is a safe and effective option for treatment of morbidly obese adolescents, resulting in significant weight loss and comorbidity resolution with a low risk of complications.
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Affiliation(s)
- Tiago Tuna
- Pediatric Surgery Department, Centro Hospitalar e Universitário de São João, Faculdade de Medicina. Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Maria do Céu Espinheira
- Pediatric Gastroenterology and Nutrition Unit, Centro Hospitalar e Universitário de São João. Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Carla Vasconcelos
- Nutrition and Dietetics Department, Centro Hospitalar e Universitário de São João. Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - John Preto
- Surgery Department, Centro Hospitalar e Universitário de São João. Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - José M Campos
- Pediatric Surgery Department, Centro Hospitalar e Universitário de São João, Faculdade de Medicina. Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
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Albakheet SS, Yoon H, Shin HJ, Koh H, Kim S, Lee MJ. Bone marrow fat change in pediatric patients with non-alcoholic fatty liver disease. PLoS One 2020; 15:e0234096. [PMID: 32484830 PMCID: PMC7266329 DOI: 10.1371/journal.pone.0234096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/18/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To investigate changes of fat in bone marrow (BM) and paraspinal muscle (PSM) associated with the degree of fatty liver in pediatric patients with non-alcoholic fatty liver disease (NAFLD) in consideration of age and body mass index (BMI). METHODS Hepatic fat, BM fat, and PSM fat from proton density fat fraction of liver MRI between June 2015 and April 2019 were quantitatively evaluated on axial images of the fat map at the mid-level of T11-L2 vertebral bodies for BM fat and at the mid-level of L2 for PSM fat. Age, height, and weight at the time of MRI were recorded and BMI was calculated. Correlation analysis was performed. RESULTS A total of 147 patients (114 male) were included with a mean age of 13.3 ± 2.9 years (range 7-18 years). The mean fat fractions were 24.3 ± 13.0% (2-53%) in liver, 37.4 ± 8.6% (17.3-56%) in vertebral BM, and 2.7 ± 1.1% (1.0-6.9%) in PSM. Age, height, weight, and BMI were not correlated with liver fat or BM fat. However, weight (ρ = 0.174, p = 0.035) and BMI (ρ = 0.247, p = 0.003) were positively correlated with PSM fat. Liver fat showed positive correlation with BM fat when adjusting age and BMI (ρ = 0.309, p<0.001), but not with PSM fat. CONCLUSIONS BM fat positively correlates with liver fat, but not with age or BMI in pediatric NAFLD patients.
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Affiliation(s)
- Salman S. Albakheet
- Department of Radiology, Severance Hospital, Severance Pediatric Liver Disease Research Group, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiology, King Faisal General Hospital, Al-Hofuf, Kingdom of Saudi Arabia
| | - Haesung Yoon
- Department of Radiology, Severance Hospital, Severance Pediatric Liver Disease Research Group, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Joo Shin
- Department of Radiology, Severance Hospital, Severance Pediatric Liver Disease Research Group, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Hong Koh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Children’s Hospital, Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Kim
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Children’s Hospital, Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, South Korea
| | - Mi-Jung Lee
- Department of Radiology, Severance Hospital, Severance Pediatric Liver Disease Research Group, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
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Abstract
UNLABELLED Nonalcoholic fatty liver disease (NAFLD), defined as fat accumulation greater than 5% in hepatocytes, may progress to fibrosis or cirrhosis later in life. NAFLD prevalence in adolescents has increased significantly in direct relation with obesity prevalence. Fatty liver has become the most frequent indication for liver transplantation in adults. OBJECTIVE The aim of the study was to identify anthropometric variables during the first 10 years of life associated to the risk of developing NAFLD in adolescence. METHODS Longitudinal cohort study 'Growth and Obesity Chilean Cohort Study' (GOCS) consisting of 513 children born in 2002 to 2003, with yearly anthropometric data collected over a 10-year period. The presence of intrahepatic fat in the livers of subjects 14 to 16 years of age was determined using abdominal ultrasound. In addition, elastography was performed on all participants with ultrasound evidence of NAFLD. RESULTS 9.7% of the participants presented findings compatible with NAFLD. After 2 years of age, obesity significantly and progressively increased the probability of NAFLD occurrence in adolescence. Obesity at 5 years of age was associated with the highest OR for NAFLD, reaching values of 8.91 (95% CI 3.03-16.11). Among participants with NAFLD, those with altered liver elasticity (≥7 kPa) had greater weight, BMI z-score, waist and hip circumference, and altered liver enzymes (P < 0.05). CONCLUSION The risk of developing NAFLD in adolescence increases progressively with early obesity starting at age 2 years.
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Hassan NE, El Ashmawi AA, El-Masry SA, Zarouk WA, Mira MF, El-Saeed GS, Dwidar OH. Metabolic syndrome in a sample of Egyptian adolescent girls and its association with apolipoprotein E. J Paediatr Child Health 2019; 55:1344-1350. [PMID: 30895669 DOI: 10.1111/jpc.14419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/21/2019] [Accepted: 02/10/2019] [Indexed: 11/28/2022]
Abstract
AIM Obesity and its metabolic complications are increasing in childhood and extend to adulthood. The aims of this study were to assess the prevalence of metabolic syndrome (MS) in a sample of Egyptian adolescent girls and investigate its association with apolipoprotein E. METHODS A cross-sectional study design was used, including 200 Egyptian adolescent girls aged between 12 and 18 years. They were subjected to blood pressure (BP) measurement, anthropometric measurements (weight, height and waist circumference (WC)), laboratory investigations (fasting glucose and lipid profile) and molecular analysis (Apo E). RESULTS Overweight/obese girls were suffering significantly, more than normal-weight girls, from hypertension (66.7 vs. 40.8%), diabetes diagnosed by elevated fasting blood glucose (46.7 vs. 31.2%) and low high-density lipoprotein (HDL) (64 vs. 59.2%). Girls with MS had significantly higher values of body mass index Z-score, WC, BP, cholesterol and triglycerides and significantly lower HDL. Allele E3 (59.1 vs. 55.1%) was more frequent among girls with MS, while allele E4 (41 vs. 36.4) was more frequent among girls without MS. MS was the most prominent among girls with the E3/E4 genotype (35.7%), who had the highest frequency of elevated cholesterol, triglycerides, low-density lipoprotein and blood glucose, while girls with the E2/E4 genotype, which was rare among both groups, had the highest frequency of elevated BP (68.8%) and low HDL (71.4%). CONCLUSION MS was significantly more prominent among overweight/obese adolescent girls with the E3/E4 genotype, who had the highest frequency of disturbed lipid profile and blood glucose.
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Affiliation(s)
- Nayera E Hassan
- Biological Anthropology Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | | | - Sahar A El-Masry
- Biological Anthropology Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Waheba A Zarouk
- Molecular Genetics and Enzymology Department, Human Genetics Division, National Research Centre, Cairo, Egypt
| | - Marwa F Mira
- Pediatrics Department, Cairo University, Cairo, Egypt
| | - Gamila Sm El-Saeed
- Medical Biochemistry Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Omar H Dwidar
- Biological Anthropology Department, Medical Research Division, National Research Centre, Cairo, Egypt
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Aksoy GK, Artan R, Aksoy C, Özdem S, Atalay A, Yılmaz A. Role of Soluble Adiponectin Receptor 2 in Non-Alcoholic Fatty Liver Disease in Children. Pediatr Gastroenterol Hepatol Nutr 2019; 22:470-478. [PMID: 31555572 PMCID: PMC6751103 DOI: 10.5223/pghn.2019.22.5.470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/02/2019] [Accepted: 02/07/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The incidence of non-alcoholic fatty liver disease (NAFLD) in children is gradually increasing. The aim of this study was to investigate the use of serum adiponectin and soluble adiponectin receptor 2 (soluble Adipo R2) levels for the diagnosis of fatty liver disease in obese and overweight children. METHODS The study included 51 obese and overweight children between the ages of 6 and 18 years diagnosed with NAFLD using ultrasonography and 20 children without fatty liver disease. Patients whose alanine transaminase level was two times higher than normal (≥80 U/L) were included in the non-alcoholic steatohepatitis (NASH) group. RESULTS NASH was observed in 11 (21.6%) of the patients with NAFLD. The incidence of obesity was higher in patients with NASH (80% and 45%, p=0.021). While the adiponectin levels were similar in patients with NAFLD and those without, they were below the normal level in the whole study group. Adiponectin and soluble Adipo R2 levels of patients with NASH were lower than those in patients without NASH; however, this difference was not statistically significant (p=0.064 and p=0.463). Soluble Adipo R2 levels in obese patients with NAFLD were higher than those in obese children without NAFLD (p<0.001). CONCLUSION Soluble adiponectin receptor 2 level is a noninvasive marker that can be used for the diagnosis of NAFLD in obese children.
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Affiliation(s)
- Gulsah Kaya Aksoy
- Department of Pediatrics, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Reha Artan
- Department of Pediatric Gastroenterology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Cihat Aksoy
- Department of Radiology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Sebahat Özdem
- Department of Biochemistry, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Atike Atalay
- Department of Pediatric Gastroenterology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Aygen Yılmaz
- Department of Pediatric Gastroenterology, Akdeniz University Medical Faculty, Antalya, Turkey
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Intraoperative Liver Biopsy During Adolescent Bariatric Surgery: Is It Really Necessary? Obes Surg 2019; 30:69-76. [DOI: 10.1007/s11695-019-04136-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Prevalence of Nonalcoholic Fatty Liver Disease in Children with Obesity. J Pediatr 2019; 207:64-70. [PMID: 30559024 PMCID: PMC6440815 DOI: 10.1016/j.jpeds.2018.11.021] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/10/2018] [Accepted: 11/07/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine the prevalence of nonalcoholic fatty liver disease (NAFLD) in children with obesity because current estimates range from 1.7% to 85%. A second objective was to evaluate the diagnostic accuracy of alanine aminotransferase (ALT) for NAFLD in children with obesity. STUDY DESIGN We evaluated children aged 9-17 years with obesity for the presence of NAFLD. Diseases other than NAFLD were excluded by history and laboratories. Hepatic steatosis was measured by liver magnetic resonance imaging proton density fat fraction. The diagnostic accuracy of ALT for detecting NAFLD was evaluated. RESULTS The study included 408 children with obesity that had a mean age of 13.2 years and mean body mass index percentile of 98.0. The study population had a mean ALT of 32 U/L and median hepatic magnetic resonance imaging proton density fat fraction of 3.7%. The estimated prevalence of NAFLD was 26.0% (95% CI 24.2%-27.7%), 29.4% in male patients (CI 26.1%-32.7%) and 22.6% in female patients (CI 16.0%-29.1%). Optimal ALT cut-point was 42 U/L (47.8% sensitivity, 93.2% specificity) for male and 30 U/L (52.1% sensitivity, 88.8% specificity) for female patients. The classification and regression tree model with sex, ALT, and insulin had 80% diagnostic accuracy for NAFLD. CONCLUSIONS NAFLD is common in children with obesity, but NAFLD and obesity are not concomitant. In children with obesity, NAFLD is present in nearly one-third of boys and one-fourth of girls.
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D'Adamo E, Castorani V, Nobili V. The Liver in Children With Metabolic Syndrome. Front Endocrinol (Lausanne) 2019; 10:514. [PMID: 31428049 PMCID: PMC6687849 DOI: 10.3389/fendo.2019.00514] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/15/2019] [Indexed: 12/17/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is recognized as an emerging health risk in obese children and adolescents. NAFLD represents a wide spectrum of liver conditions, ranging from asymptomatic steatosis to steatohepatitis. The growing prevalence of fatty liver disease in children is associated with an increased risk of metabolic and cardiovascular complications. NAFLD is considered the hepatic manifestation of Metabolic Syndrome (MetS) and several lines of evidence have reported that children with NAFLD present one or more features of MetS. The pathogenetic mechanisms explaining the interrelationships between fatty liver disease and MetS are not clearly understood. Altough central obesity and insulin resistance seem to represent the core of the pathophysiology in both diseases, genetic susceptibility and enviromental triggers are emerging as crucial components promoting the development of NAFLD and MetS in children. In the present review we have identified and summarizied studies discussing current pathogenetic data of the association between NAFLD and MetS in children.
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Affiliation(s)
- Ebe D'Adamo
- Department of Neonatology, University of Chieti, Chieti, Italy
- *Correspondence: Ebe D'Adamo
| | | | - Valerio Nobili
- Department of Pediatrics, University “La Sapienza”, Rome, Italy
- Hepatology, Gastroenterology and Nutrition Unit, IRCCS “Bambino Gesù” Children's Hospital, Rome, Italy
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Body fat percentage is better than indicators of weight status to identify children and adolescents with unfavorable lipid profile. J Pediatr (Rio J) 2019; 95:112-118. [PMID: 29306717 DOI: 10.1016/j.jped.2017.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/01/2017] [Accepted: 11/08/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To assess whether the indicators of weight status body mass index and waist-to-height ratio are similar to body fat percentage to identify obese children and adolescents with unfavorable lipid profile. METHODS This was a cross-sectional study involving 840 children and adolescents (6-18 years). The same individuals were classified as non-obese (<P95) or obese (≥P95) according to body fat percentage and indicators of weight status, body mass index, and waist-to-height ratio. Body fat percentage was obtained by multi-frequency bioelectrical impedance. Linear association between obesity and increased lipid fractions was tested by ANCOVA. Normal distribution curves of non-HDL cholesterol were designed for obese and non-obese. To provide the proportion of obese individuals with elevated non-HDL-c across all indicators, Z-score was calculated. RESULTS Obese boys presented higher non-HDL cholesterol when compared with those non-obese, classified by body mass index (107±28 vs. 94±25mg/dL, p=0.001), waist-to-height ratio (115±29 vs. 94±25mg/dL, p<0.001) and body fat percentage (119±33 vs. 94±24mg/dL, p<0.001). Differently, obese girls presented with higher non-HDL cholesterol when compared with those non-obese only according to the body fat percentage classification (118±24 vs. 96±26mg/dL, p=0.001). A large shift to the right in the distribution curve of non-HDL cholesterol among obese girls compared with non-obese was observed only when body fat percentage was used to discriminate between obese and non-obese. CONCLUSION Body fat percentage was better than the indicators of weight status to identify children and adolescents with unfavorable lipid profile, mainly among girls.
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Oliosa PR, Zaniqueli D, Alvim RDO, Barbosa MCR, Mill JG. Body fat percentage is better than indicators of weight status to identify children and adolescents with unfavorable lipid profile. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) and its Clinical Characteristics in Overweight and Obese Children in the South East of Iran, 2017. HEPATITIS MONTHLY 2018. [DOI: 10.5812/hepatmon.83525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Elhag W, El Ansari W, Abdulrazzaq S, Abdullah A, Elsherif M, Elgenaied I. Evolution of 29 Anthropometric, Nutritional, and Cardiometabolic Parameters Among Morbidly Obese Adolescents 2 Years Post Sleeve Gastrectomy. Obes Surg 2018; 28:474-482. [PMID: 28822064 PMCID: PMC5778185 DOI: 10.1007/s11695-017-2868-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Laparoscopic sleeve gastrectomy (LSG) is a popular treatment for adolescent morbid obesity. Research on LSG outcomes among adolescents assessed a narrow range of anthropometric, nutritional, or cardiometabolic parameters, leading to an incomplete picture of these changes. We examined a wide variety of anthropometric, nutritional, and cardiometabolic parameters among adolescents before and after LSG. Methods We retrospectively reviewed medical charts of all obese adolescents who underwent LSG at Hamad Medical Corporation, Qatar, between January 2011 and June 2015 (N = 102). We assessed preoperative levels and postoperative changes in 4 anthropometric, 15 nutritional, and 10 cardiometabolic parameters. Results The study sample comprised 79 patients with complete information (36 males, mean age 15.99 ± 1.1 years). At a mean of 24.2 months post-LSG, we observed (1) significantly reduced mean weight and body mass index by 51.82 ± 28.1 kg and 17 ± 6.24 kg/m2, respectively; (2) the highest prevalence of post-LSG deficiencies pertained to vitamin D, albumin, and ferritin (89.3, 38, and 33.3%, respectively); (3) low hemoglobin levels (29.3%) only in females; (4) trace elements were not deficient; (4) significant reductions in percentage of adolescents with elevated low-density lipoprotein (from 66.1 to 38.9%), alanine aminotransferase (from 45.3 to 10.9%), and aspartate aminotransferase (from 24.1 to 8.6%) levels; (5) 100% remission of prediabetes cases; and (6) 80% remission of type 2 diabetes cases. Conclusions LSG achieved significant weight loss and improvement of cardiometabolic risk factors among adolescents. However, the slight worsening of preexisting nutritional deficiencies warrants careful preoperative surveillance and appropriate postoperative nutritional supplementation.
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Affiliation(s)
- Wahiba Elhag
- Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, State of Qatar. .,College of Medicine, Qatar University, Doha, State of Qatar. .,School of Health and Education, University of Skövde, Skövde, Sweden.
| | - Sama Abdulrazzaq
- Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
| | - Ali Abdullah
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
| | - Mohamed Elsherif
- Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
| | - Israa Elgenaied
- Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
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Akki AS, Chung SM, Rudolph BJ, Ewart MR. Differential Diagnosis of a Patient with Lysosomal Acid Lipase Deficiency: A Case Report. Lab Med 2018; 49:377-384. [PMID: 29982809 DOI: 10.1093/labmed/lmy027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND We describe the differential diagnosis of an obese 12-year-old boy of Mexican origin who presented with a 6-year history of abnormal lipid profile and elevated liver transaminase levels. METHODS The patient underwent routine clinical testing, an abdominal ultrasound and, ultimately, a liver biopsy. Based on the histologic findings, a serum leukocyte lysosomal acid lipase (LAL) assay and DNA sequencing of the lipase A (LIPA) gene were performed. RESULTS Liver biopsy revealed diffuse microvesicular steatosis with clusters of foamy histiocytes in the lobules and portal areas. Our differential diagnosis included nonalcoholic fatty liver disease; medication-induced hepatotoxicity; glycogenic hepatopathy; medium-chain acyl coenzyme A dehydrogenase or long-chain acyl coenzyme A dehydrogenase deficiency; and lysosomal storage disorders, including Niemann-Pick disease and lysosomal acid lipase deficiency (LAL-D). Serum LAL activity was absent, and DNA sequencing confirmed homozygous mutation in LIPA. CONCLUSIONS Although it occurs rarely, LAL-D should be considered in the differential diagnosis of microvesicular steatosis for a timely diagnosis.
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Affiliation(s)
- Ashwin S Akki
- Department of Pathology, Montefiore Medical Center, Bronx, NY
| | - Sun M Chung
- Department of Pathology, Montefiore Medical Center, Bronx, NY
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Abstract
Nonalcoholic fatty liver disease (NAFLD), an increasingly prevalent paediatric disorder, is diagnosed and managed not only by both pediatric gastroenterologists/hepatologists but also frequently by the general pediatrician. This article updates recent advances in diagnostic and therapeutic approach, which may be applied to everyday practice. Diagnosis of NAFLD takes into account the risk factor profile and is a diagnosis of exclusion. Techniques such as transient elastography and specific biomarkers aimed at improving diagnosis and monitoring of NAFLD need further validation in the pediatric population. Defining the risk to develop cirrhosis seems to be of primary importance already in childhood and a combination of genetic, clinical, and environmental factors can help in monitoring and making decisions on therapy. Weight reduction therapy should be the aim of treatment approach, but the compliance is poor and pharmacological treatment would be helpful; docosahexaenoic acid, some probiotics, and vitamin E are to be considered, but evidence is not sufficient to recommend widespread use.
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Affiliation(s)
- Valerio Nobili
- Hepatometabolic Diseases Unit and Liver Research Unit Bambino Gesu Children Hospital, Rome.,Pediatric Department University La Sapienza-Rome, Italy
| | - Piotr Socha
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warszawa, Poland
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