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Cohen CC, Perng W, Sundaram SS, Scherzinger A, Shankar K, Dabelea D. Hepatic Fat in Early Childhood Is Independently Associated With Estimated Insulin Resistance: The Healthy Start Study. J Clin Endocrinol Metab 2021; 106:3140-3150. [PMID: 34289064 PMCID: PMC8530740 DOI: 10.1210/clinem/dgab541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Fatty liver disease is a common metabolic abnormality in adolescents with obesity but remains understudied in early childhood. OBJECTIVES To describe hepatic fat deposition in prepubertal children and examine cross-sectional associations with metabolic markers and body composition. METHODS Data were from 286 children ages 4 to 8 years old in the Healthy Start Study, a longitudinal prebirth cohort in Colorado (USA). Assessments included magnetic resonance imaging to quantify hepatic and abdominal fats, fasting blood draws to measure metabolic markers, and air displacement plethysmography to measure body composition (fat mass and fat-free mass). RESULTS The median (interquartile range) for hepatic fat was 1.65% (1.24%, 2.11%). Log-transformed hepatic fat was higher in Hispanic [mean (95% CI): 0.63 (0.52, 0.74)] vs non-Hispanic white children [0.46 (0.38, 0.53), P = 0.01] and children with overweight/obesity [0.64 (0.49, 0.79)] vs normal-weight [0.47 (0.40, 0.53), P = 0.02]. Higher log-hepatic fat was associated with higher insulin [β (95% CI): 1.47 (0.61, 2.33) uIU/mL, P = 0.001] and estimated insulin resistance (homeostatic model assessment) [0.40 (0.20, 0.60), P < 0.001] in the full sample and glucose [5.53 (2.84, 8.21) mg/dL, P < 0.001] and triglycerides [10.92 (2.92,18.91) mg/dL, P = 0.008] in boys, in linear regression models adjusted for sociodemographics, maternal/perinatal confounders, and percentage body fat. Log-hepatic fat was also associated with abdominal subcutaneous adipose tissue [SAT; 7.37 (1.12,13.60) mm2, P = 0.02] in unadjusted models, but this was attenuated and insignificant after adjusting for confounders. CONCLUSIONS While hepatic fat was low in children 4 to 8 years old, it was independently associated with estimated insulin resistance and exhibited sex-specific associations with glucose and triglycerides, suggesting hepatic fat may be an early indicator of metabolic dysfunction in youth.
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Affiliation(s)
- Catherine C Cohen
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Shikha S Sundaram
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Ann Scherzinger
- Department of Radiology, University of Colorado, School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Kartik Shankar
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Dana Dabelea
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Correspondence: Dana Dabelea, MD, PhD, 13001 East 17th Ave, Box B119, Room W3110, Aurora, CO 80045, USA.
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Tzifi F, Fretzayas A, Chrousos G, Kanaka-Gantenbein C. Non-alcoholic fatty liver infiltration in children: an underdiagnosed evolving disease. Hormones (Athens) 2019; 18:255-265. [PMID: 31140156 DOI: 10.1007/s42000-019-00107-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/25/2019] [Indexed: 12/21/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) constitutes the most common liver disease, one that is still underdiagnosed in pediatric populations (as well as in the general population), this due to the progressive increase in childhood obesity observed both in developed and developing countries during the last few decades. The pathophysiology of the disease has not been thoroughly clarified yet. The condition displays common pathways in adults and children; however, there are age-related differences. Unlike adults, children with NAFLD require extensive laboratory analysis, because underlying pathologies other than obesity may contribute to the evolution of the disease. Despite the presence of several serum markers and imaging techniques that contribute to NAFLD diagnosis, liver biopsy remains the gold standard diagnostic procedure. Early intervention and obesity prevention are mandatory, as NAFLD is reversible at an early stage. If left undiagnosed and untreated, NAFLD can progress to steatohepatitis (NASH) and subsequent liver failure, a potentially lethal complication. Of note, there are no treatment options when advanced liver fibrosis occurs. This review summarizes literature data on NAFLD in childhood indicating that this is an evolving disease and a significant component of the metabolic syndrome. Pediatricians should be aware of this entity, screening children at high risk and providing appropriate early management, in collaboration with pediatric subspecialists.
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Affiliation(s)
- Flora Tzifi
- First Department of Pediatrics, Division of Endocrinology, Diabetes and Metabolism, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece.
- Athens Medical Group, Marousi, Greece.
| | | | - George Chrousos
- First Department of Pediatrics, Division of Endocrinology, Diabetes and Metabolism, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Christina Kanaka-Gantenbein
- First Department of Pediatrics, Division of Endocrinology, Diabetes and Metabolism, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
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Maffeis C, Morandi A. Body composition and insulin resistance in children. Eur J Clin Nutr 2018; 72:1239-45. [DOI: 10.1038/s41430-018-0239-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 12/21/2022]
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Strait RB, Slattery MJ, Carrel AL, Eickhoff J, Allen DB. Salivary Cortisol Does Not Correlate with Metabolic Syndrome Markers or Subjective Stress in Overweight Children. ACTA ACUST UNITED AC 2018; 3. [PMID: 29998225 DOI: 10.21767/2572-5394.100048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective Being overweight is a risk factor for metabolic syndrome in children, but not all overweight children develop metabolic syndrome. Cortisol excess from chronic psychological stress has been proposed as an independent risk factor for metabolic syndrome in this already at-risk population. The present study assesses the relationship of biochemical and body composition radiographic markers of metabolic syndrome to salivary cortisol and self-report of chronic psychological stress in a cohort of overweight children. Methods This cross-sectional study took place in a multi-disciplinary pediatric obesity clinic at a tertiary care hospital, and involved fifteen children with BMI at or above the 85th percentile for age and sex, 10 of whom provided salivary cortisol samples. The main outcomes measured were salivary bedtime cortisol, first-waking cortisol, and cortisol awakening response (CAR-the rise in cortisol in the first half hour after waking); fasting serum triglycerides, HDL cholesterol, glucose and insulin for HOMA-IR; the ratio of abdominal fat to total body fat by DXA scan; and scores of validated stress and bullying questionnaires (PANAS-C, PSS, and SEC-Q). Results In this pilot study, no correlation was found between salivary cortisol measures and questionnaire scores of subjective stress or bullying, and no correlation was found between any of these measures and markers of metabolic syndrome (dyslipidemia, insulin resistance, increased abdominal fat). Conclusions These results suggest that measures of psychological stress, whether biochemical or subjective, do not appear to predict risk of metabolic syndrome in overweight children. While ease of collection and demonstrated utility both in detection of pediatric Cushing disease and in adult psychological research make salivary cortisol assessment an attractive clinical tool, further investigation into the value of salivary measures in pediatric stress research is needed.
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Affiliation(s)
- Robert B Strait
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, H4-436, Madison WI, 53792
| | - Marcia J Slattery
- Department of Child and Adolescent Psychiatry, University of Wisconsin School of Medicine and Public Health, 6001 Research Park Blvd, Madison, WI 53719
| | - Aaron L Carrel
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, H4-436, Madison WI, 53792
| | - Jens Eickhoff
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, H4-436, Madison WI, 53792
| | - David B Allen
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, H4-436, Madison WI, 53792
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Ohman-Hanson RA, Cree-Green M, Kelsey MM, Bessesen DH, Sharp TA, Pyle L, Pereira RI, Nadeau KJ. Ethnic and Sex Differences in Adiponectin: From Childhood to Adulthood. J Clin Endocrinol Metab 2016; 101:4808-4815. [PMID: 27603898 PMCID: PMC5155686 DOI: 10.1210/jc.2016-1137] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
CONTEXT Insulin resistance (IR) and type 2 diabetes are increasing, particularly in Hispanic (H) vs non-Hispanic White (NHW) populations. Adiponectin has a known role in IR, and therefore, understanding ethnic and sex-specific behavior of adiponectin across the lifespan is of clinical significance. OBJECTIVE To compare ethnic and sex differences in adiponectin, independent of body mass index, across the lifespan and relationship to IR. DESIGN Cross-sectional. SETTING Primary care, referral center. PATIENTS A total of 187 NHW and 117 H participants (8-57 y) without diabetes. Life stage: pre-/early puberty (Tanner 1/2), midpubertal (Tanner 3/4), late pubertal (Tanner 5, <21 years), and adult (Tanner 5, ≥21). INTERVENTIONS None. MAIN OUTCOME MEASURE(S) Fasting adiponectin, insulin, glucose, and revised homeostatic model assessment of insulin resistance. RESULTS Adiponectin was significantly inversely correlated with revised homeostatic model assessment of insulin resistance. Regarding puberty, adiponectin trended downward in late puberty, but only males were significantly lower in adulthood. By sex, adiponectin was lower in adult males vs females of both ethnicities. Regarding ethnicity, H adults of both sexes had lower adiponectin than NHW adults. Of note, in NHW females, adiponectin trended highest in adulthood, whereas in H females, adiponectin fell in late puberty and remained lower in adulthood. CONCLUSIONS Adiponectin inversely correlated with IR, trended down in late puberty, and was lowest in adult males. H adults of both sexes had lower adiponectin than NHW adults, and H females followed a more "male pattern," lacking the rebound in adiponectin seen in NHW females after puberty. These data suggest that adiponectin, independent of body mass index, may relate to the greater cardiometabolic risk seen in H populations and in particular H females.
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Affiliation(s)
- Rebecca A Ohman-Hanson
- Pediatric Endocrinology (R.O.-H., M.C.-G., M.M.K., K.J.N.), University of Colorado School of Medicine, Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado 80045; Endocrinology (D.H.B., R.I.P.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado 80045; Colorado School of Public Health at the University of Northern Colorado (T.A.S.), Greeley, Colorado 80639; Department of Pediatrics (L.P.), University of Colorado School of Medicine, Aurora, Colorado 80045; and Department of Biostatistics and Informatics (L.P.), Colorado School of Public Health, Aurora, Colorado 80045
| | - Melanie Cree-Green
- Pediatric Endocrinology (R.O.-H., M.C.-G., M.M.K., K.J.N.), University of Colorado School of Medicine, Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado 80045; Endocrinology (D.H.B., R.I.P.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado 80045; Colorado School of Public Health at the University of Northern Colorado (T.A.S.), Greeley, Colorado 80639; Department of Pediatrics (L.P.), University of Colorado School of Medicine, Aurora, Colorado 80045; and Department of Biostatistics and Informatics (L.P.), Colorado School of Public Health, Aurora, Colorado 80045
| | - Megan M Kelsey
- Pediatric Endocrinology (R.O.-H., M.C.-G., M.M.K., K.J.N.), University of Colorado School of Medicine, Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado 80045; Endocrinology (D.H.B., R.I.P.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado 80045; Colorado School of Public Health at the University of Northern Colorado (T.A.S.), Greeley, Colorado 80639; Department of Pediatrics (L.P.), University of Colorado School of Medicine, Aurora, Colorado 80045; and Department of Biostatistics and Informatics (L.P.), Colorado School of Public Health, Aurora, Colorado 80045
| | - Daniel H Bessesen
- Pediatric Endocrinology (R.O.-H., M.C.-G., M.M.K., K.J.N.), University of Colorado School of Medicine, Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado 80045; Endocrinology (D.H.B., R.I.P.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado 80045; Colorado School of Public Health at the University of Northern Colorado (T.A.S.), Greeley, Colorado 80639; Department of Pediatrics (L.P.), University of Colorado School of Medicine, Aurora, Colorado 80045; and Department of Biostatistics and Informatics (L.P.), Colorado School of Public Health, Aurora, Colorado 80045
| | - Teresa A Sharp
- Pediatric Endocrinology (R.O.-H., M.C.-G., M.M.K., K.J.N.), University of Colorado School of Medicine, Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado 80045; Endocrinology (D.H.B., R.I.P.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado 80045; Colorado School of Public Health at the University of Northern Colorado (T.A.S.), Greeley, Colorado 80639; Department of Pediatrics (L.P.), University of Colorado School of Medicine, Aurora, Colorado 80045; and Department of Biostatistics and Informatics (L.P.), Colorado School of Public Health, Aurora, Colorado 80045
| | - Laura Pyle
- Pediatric Endocrinology (R.O.-H., M.C.-G., M.M.K., K.J.N.), University of Colorado School of Medicine, Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado 80045; Endocrinology (D.H.B., R.I.P.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado 80045; Colorado School of Public Health at the University of Northern Colorado (T.A.S.), Greeley, Colorado 80639; Department of Pediatrics (L.P.), University of Colorado School of Medicine, Aurora, Colorado 80045; and Department of Biostatistics and Informatics (L.P.), Colorado School of Public Health, Aurora, Colorado 80045
| | - Rocio I Pereira
- Pediatric Endocrinology (R.O.-H., M.C.-G., M.M.K., K.J.N.), University of Colorado School of Medicine, Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado 80045; Endocrinology (D.H.B., R.I.P.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado 80045; Colorado School of Public Health at the University of Northern Colorado (T.A.S.), Greeley, Colorado 80639; Department of Pediatrics (L.P.), University of Colorado School of Medicine, Aurora, Colorado 80045; and Department of Biostatistics and Informatics (L.P.), Colorado School of Public Health, Aurora, Colorado 80045
| | - Kristen J Nadeau
- Pediatric Endocrinology (R.O.-H., M.C.-G., M.M.K., K.J.N.), University of Colorado School of Medicine, Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado 80045; Endocrinology (D.H.B., R.I.P.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado 80045; Colorado School of Public Health at the University of Northern Colorado (T.A.S.), Greeley, Colorado 80639; Department of Pediatrics (L.P.), University of Colorado School of Medicine, Aurora, Colorado 80045; and Department of Biostatistics and Informatics (L.P.), Colorado School of Public Health, Aurora, Colorado 80045
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Abstract
Conventional imaging modalities, including ultrasonography (US), computed tomography (CT), and magnetic resonance (MR), play an important role in the diagnosis and management of patients with nonalcoholic fatty liver disease (NAFLD) by allowing noninvasive diagnosis of hepatic steatosis. However, conventional imaging modalities are limited as biomarkers of NAFLD for various reasons. Multi-parametric quantitative MRI techniques overcome many of the shortcomings of conventional imaging and allow comprehensive and objective evaluation of NAFLD. MRI can provide unconfounded biomarkers of hepatic fat, iron, and fibrosis in a single examination-a virtual biopsy has become a clinical reality. In this article, we will review the utility and limitation of conventional US, CT, and MR imaging for the diagnosis NAFLD. Recent advances in imaging biomarkers of NAFLD are also discussed with an emphasis in multi-parametric quantitative MRI.
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Affiliation(s)
- Sonja Kinner
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Scott B Reeder
- Department of Radiology, Medical Physics, Biomedical Engineering, Medicine, Emergency Medicine, University of Wisconsin, Madison, WI, USA
| | - Takeshi Yokoo
- Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA.
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Abstract
Sex hormone-binding globulin (SHBG) is a circulating glycoprotein that transports testosterone and other steroids in the blood. Interest in SHBG has escalated in recent years because of its inverse association with obesity and insulin resistance, and because many studies have linked lower circulating levels of SHBG to metabolic syndrome, type 2 diabetes, nonalcoholic fatty liver disease, polycystic ovary syndrome, and early puberty. The purpose of this review is to summarize molecular, clinical, endocrine, and epidemiological findings to illustrate how measurement of plasma SHBG may be useful in clinical medicine in children.
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Affiliation(s)
- Banu Aydın
- University of Louisville Faculty of Medicine, Division of Endocrinology, Metabolism and Diabetes, Kentucky, USA
| | - Stephen J. Winters
- University of Louisville Faculty of Medicine, Division of Endocrinology, Metabolism and Diabetes, Kentucky, USA
,* Address for Correspondence: University of Louisville Faculty of Medicine, Division of Endocrinology, Metabolism and Diabetes, Kentucky, USA Phone: +1 502 852 52 37 E-mail:
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Wolfgram PM, Connor EL, Rehm JL, Eickhoff JC, Zha W, Reeder SB, Allen DB. In Nonobese Girls, Waist Circumference as a Predictor of Insulin Resistance Is Comparable to MRI Fat Measures and Superior to BMI. Horm Res Paediatr 2015; 84:258-65. [PMID: 26352642 PMCID: PMC4644098 DOI: 10.1159/000439130] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/31/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate the degree to which waist circumference (WC), body mass index (BMI), and magnetic resonance imaging (MRI)-measured abdominal fat deposition predict insulin resistance (IR) in nonobese girls of diverse racial and ethnic backgrounds. METHODS Fifty-seven nonobese girls (12 African-American, 16 Hispanic White, and 29 non-Hispanic White girls) aged 11-14 years were assessed for WC, MRI hepatic proton density fat fraction, visceral and subcutaneous adipose tissue volume, BMI Z-score, fasting insulin, homeostasis model of assessment (HOMA)-IR, adiponectin, leptin, sex hormone-binding globulin, high-density lipoprotein cholesterol, and triglycerides. RESULTS Univariate and multivariate analyses adjusted for race and ethnicity indicated that only WC and visceral adipose tissue volume were independent predictors of fasting insulin and HOMA-IR, while hepatic proton density fat fraction, BMI Z-score, and subcutaneous adipose tissue volume were dependent predictors. Hispanic White girls showed significantly higher mean fasting insulin and HOMA-IR and lower sex hormone-binding globulin than non-Hispanic White girls (p < 0.01). CONCLUSIONS In nonobese girls of diverse racial and ethnic backgrounds, WC, particularly when adjusted for race or ethnicity, is an independent predictor of IR comparable to MRI-derived measurements of fat and superior to the BMI Z-score.
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Affiliation(s)
- Peter M. Wolfgram
- Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ellen L. Connor
- Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - Jennifer L. Rehm
- Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - Jens C. Eickhoff
- Biostatistics and Medical Informatics, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - Wei Zha
- Medical Physics, Biomedical Engineering, Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - Scott B. Reeder
- Medical Physics, Biomedical Engineering, Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States,Radiology, Medical Physics, Biomedical Engineering, Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - David B. Allen
- Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
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Rehm JL, Connor EL, Wolfgram P, Eickhoff JC, Reeder SB, Allen DB. Predicting hepatic steatosis in a racially and ethnically diverse cohort of adolescent girls. J Pediatr 2014; 165:319-325.e1. [PMID: 24857521 PMCID: PMC4131842 DOI: 10.1016/j.jpeds.2014.04.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/17/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop a risk assessment model for early detection of hepatic steatosis using common anthropometric and metabolic markers. STUDY DESIGN This was a cross-sectional study of 134 adolescent and young adult females, age 11-22 years (mean 13.3±2 years) from a middle school and clinics in Madison, Wisconsin. The ethnic distribution was 27% Hispanic and 73% non-Hispanic; the racial distribution was 64% Caucasian, 31% African-American, and 5% Asian, Fasting glucose, fasting insulin, alanine aminotransferase (ALT), body mass index (BMI), waist circumference (WC), and other metabolic markers were assessed. Hepatic fat was quantified using magnetic resonance imaging proton density fat fraction (MR-PDFF). Hepatic steatosis was defined as MR-PDFF>5.5%. Outcome measures were sensitivity, specificity, and positive predictive value (PPV) of BMI, WC, ALT, fasting insulin, and ethnicity as predictors of hepatic steatosis, individually and combined, in a risk assessment model. Classification and regression tree methodology was used to construct a decision tree for predicting hepatic steatosis. RESULTS MR-PDFF revealed hepatic steatosis in 16% of subjects (27% overweight, 3% nonoverweight). Hispanic ethnicity conferred an OR of 4.26 (95% CI, 1.65-11.04; P=.003) for hepatic steatosis. BMI and ALT did not independently predict hepatic steatosis. A BMI>85% combined with ALT>65 U/L had 9% sensitivity, 100% specificity, and 100% PPV. Lowering the ALT value to 24 U/L increased the sensitivity to 68%, but reduced the PPV to 47%. A risk assessment model incorporating fasting insulin, total cholesterol, WC, and ethnicity increased sensitivity to 64%, specificity to 99% and PPV to 93%. CONCLUSION A risk assessment model can increase specificity, sensitivity, and PPV for identifying the risk of hepatic steatosis and guide the efficient use of biopsy or imaging for early detection and intervention.
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Affiliation(s)
- Jennifer L Rehm
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Ellen L Connor
- Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - Peter Wolfgram
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jens C Eickhoff
- Biostatistics and Medical Informatics, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - Scott B Reeder
- Radiology, Medical Physics, Biomedical Engineering, Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - David B Allen
- Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
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Seibert TS, Allen DB, Carrel AL. Adolescent Obesity and Its Risks: How to Screen and When to Refer. J Clin Outcomes Manag 2014; 21:87-96. [PMID: 25892905 PMCID: PMC4399800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Tasa S Seibert
- Department of Pediatrics, University of Wisconsin, Madison, WI
| | - David B Allen
- Department of Pediatrics, University of Wisconsin, Madison, WI
| | - Aaron L Carrel
- Department of Pediatrics, University of Wisconsin, Madison, WI
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