Pediatric percentiles for transient elastography measurements - effects of age, sex, weight status and pubertal stage

Elastographic evaluation for fatty liver disease in north Indian children and adolescents with type 1 diabetes

OBJECTIVES

The prevalence and predisposing factors to metabolic dysfunction-associated fatty liver disease (MAFLD) in children with type 1 Diabetes (T1D) living in developing countries are unknown.

METHODS

A cross-sectional study was conducted in children with T1D. The presence of liver fat and tissue stiffness were assessed by ultrasonography and shear-wave elastography (SWE), respectively. The SWE values were correlated to body mass index (BMI), glycemic control, disease duration, and gamma-glutamyl transferase (GGT). Healthy non-obese children (n=36) were recruited as controls.

RESULTS

One hundred children with T1D were grouped (Group A-C) according to the disease duration (<5, 5-10, and >10 years, respectively). The mean diabetes duration and glycated hemoglobin were 5.9 ± 4.0 years and 8.2 ± 0.55 %, respectively. The mean SWE values were significantly higher in the patient groups compared to controls (5.07 ± 0.67, 5.27 ± 0.65, 5.16 ± 0.50, vs. 4.80 ± 0.82 kPa, p-value 0.006). The liver stiffness based on SWE showed a positive but weak relationship with BMI, diabetes duration, glycemic control, and GGT levels. A significantly higher number of children with T1D had MAFLD [9(20 %), 7(24.1 %), 7(26.9 %), vs. 1(3 %), p-value <0.001] based on ultrasonography.

CONCLUSIONS

Children with T1D showed higher liver stiffness values than controls. A weakly positive relationship of liver stiffness was observed with BMI, duration of diabetes, glycemic control, and serum GGT. Approximately one-fourth of children with diabetes showed sonographic evidence of hepatic steatosis. Larger studies are needed to ascertain the effects of obesity, diabetes duration, and metabolic control on the prevalence and progression of MAFLD in children with T1D.

Noninvasive Assessment of Nonalcoholic Fatty Liver Disease in Children with Overweight and Obesity by Transient Elastography

Introduction

Childhood obesity and nonalcoholic fatty liver disease (NAFLD) are emerging as significant health concerns. While liver biopsy remains the gold standard for diagnosis, there is a pressing need for a noninvasive alternative to identify early fibrosis.

Methods

A cross-sectional investigation was carried out from January 2020 to December 2021 involving overweight and obese children attending the pediatric outpatient department (OPD). The aim is to determine the occurrence of fibrotic and steatotic changes in the liver of overweight and obese children using transient elastography (TE) and to establish correlations between TE results, Pediatric NAFLD Fibrosis Index (PNFI), and other biochemical parameters. TE was utilized to assess both fibrotic and steatosis changes, while ultrasound (USG) was employed to detect steatosis in the liver.

Results

Two hundred and fifty-nine eligible children participated in the study. Mean age of the study cohort was 10.8 years, with males constituting 63%. Mean Z score for BMI was 1.71 ± 0.57. Fibrosis was detected in 29.3% of children by TE, while steatosis was observed in 27.7% of children. Steatosis was identified in 23.8% of cases through USG. BMI Z score, ALT (Alanine aminotransferase), AST and PNFI score exhibited significant associations with grades of liver fibrosis and steatosis as determined by TE, as well as with grades of steatosis according to USG findings.

Conclusion

A notable prevalence of increased liver stiffness was observed in overweight and obese children. TE proves to be a valuable tool in identifying fibrotic and steatotic changes in these children, complementing existing noninvasive modalities.

Clinical research of fibroscan ‒ TE-CAP at noninvasive diagnosis of hepatic steatosis in children

BACKGROUND & AIMS

The authors assess the diagnostic accuracy of the Transient Elastography-Controlled Attenuation Parameter (TE-CAP) in children of Southern China.

METHODS

105 obese or overweight children and adolescents were enrolled in the diagnostic test of TE-CAP assessment of hepatic steatosis using MRI-PDFF. Hepatic steatosis grades S0-S3 were classified. Statistical correlation, agreement and consistency between methods were evaluated. The diagnostic efficiency of TE-CAP was evaluated. The authors used the cutoff value of TE-CAP to detect hepatic steatosis in another 356 children.

RESULTS

The Area Under Curve (AUC) of TE-CAP for grade ≥ S1, ≥ S2, and ≥ S3 steatosis were 0.975, 0.984, and 0.997, respectively. For detecting ≥ S1 steatosis, TE-CAP had a sensitivity of 96 % and a specificity of 97 %. For detecting ≥ S2 steatosis, TE-CAP had a sensitivity of 97 % and a specificity of 93 %. For detecting ≥ S3 steatosis, TE-CAP had a sensitivity of 1 and a specificity of 94 %. TE-CAP and MRI-PDFF had a linear correlation (r = 0. 0.87, p < 0.001). The hepatic steatosis was identified in 40.2 % (143/356) of children in which the obesity and overweight were 69.8 % (113/162) and 40.0 % (18/45).

CONCLUSION

TE-CAP showed excellent diagnostic accuracy in pediatric hepatic steatosis.

Obesity and Body Composition in Relation to Liver and Kidney Ultrasound Elastography in Paediatric Patients with Either Hypertension or Chronic Kidney Disease

(1) Background: Ultrasound elastography is a novel ultrasound technique for evaluating tissue elasticity. One of the key factors influencing the measurement in children is excess weight. This study aimed to evaluate the effect of body composition, namely, fat mass, on liver and kidney ultrasound elastography in paediatric patients. (2) Methods: 114 participants, in whom bioimpedance, along with liver and kidney ultrasound elastography, were performed, were included (37 patients with chronic kidney disease, 46 patients with hypertension, and 31 healthy subjects). (3) Results: Bioimpedance analysis showed a significant correlation between liver elastography parameters and the phase angle (p = 0.002), fat-free mass (p = 0.001), body cell mass (p = 0.001), total body water (p = 0.001), extracellular water (p = 0.006), and, to lesser extent, fat mass (p = 0.041). On the contrary, kidney elastography parameters strongly correlated only with fat mass (p < 0.001 for both kidneys). (4) Conclusions: Liver and kidney stiffness increased in overweight participants and showed significant correlation with fat mass, particularly in the case of kidney elastography.