Development of a prediction protocol for the screening of metabolic associated fatty liver disease in children with overweight or obesity

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.

Hip and wrist accelerometers showed consistent associations with fitness and fatness in children aged 8-12 years

AIM

Physical activity (PA) has traditionally been measured wearing accelerometers on the hip, but they are increasingly being worn on the wrist. We compared hip and wrist accelerometers with regard to their acceptability and any associations between PA and fatness and fitness.

METHODS

This cross-sectional study comprised 103 children aged 8-12 years (62% boys) who participated in the ActiveBrains trial by the University of Granada, Spain, in 2014-2016. The children wore both ActiGraph GT3X+ hip and wrist accelerometers round the clock for 7 days. The acceptability of both placements was evaluated by a questionnaire, while the children's fat mass index, waist circumference and cardiorespiratory fitness (CRF) were assessed.

RESULTS

Wearing wrist accelerometers caused less disturbance, mainly because hip accelerometers caused more issues during the night. The measurements from both placements showed that lower PA levels were associated with fatness and that higher PA levels were associated with better CRF.

CONCLUSION

Both placements showed consistent results with regard to measuring associations between PA levels and fatness and fitness. However, wearing them on the wrist caused less discomfort at night. Future studies are needed to confirm the best placement for accelerometers during PA studies.

General intelligence was associated with academic achievement but not fitness in adolescents after one year

AIM

This study investigated whether general intelligence could predict physical fitness and academic achievements one year later.

METHODS

We recruited 129 Spanish adolescents (57.4% boys) with a mean age of 13.6 ± 0.7 years old from a convenience sample of a single public-funded school. The first step was to assess general intelligence during the 2015-2016 school year using the D48 nonverbal test. A year later, we collected data on fitness and academic achievements. Cardiorespiratory fitness was measured with the 20-m endurance shuttle run test, muscular strength with the standing long jump and flexibility with the sit and reach test. Academic achievement was measured using school grades. The findings were assessed using three models with different variables.

RESULTS

One year later, general intelligence at baseline was marginally significantly associated with flexibility (p = 0.079) and mathematics (p = 0.084) in the first model, with mathematics (p = 0.029) and geography and history (p = 0.016) in the second model and with geography and history (p = 0.022) in the third model. All the analyses were controlled by age, sex, fitness and academic achievement.

CONCLUSION

General intelligence may not predict fitness, but it may predict academic achievements in adolescents one year later. Further studies are needed to examine our findings.

Active commuting to school was inversely associated with academic achievement in primary but not secondary school students

AIM

Physical activity has numerous benefits for children when it comes to academic achievements. This study determined whether active commuting - walking or cycling - to school, as a way of increasing total physical activity levels, was associated with academic achievements in students aged seven to 18 years.

METHODS

A total of 2138 students participated in the study, which took place in the 2012/2013 academic year in three Spanish cities. We used a self-reported questionnaire to assess how the students travelled to and from school and their final school grades.

RESULTS

We enrolled 489 primary schoolchildren and 1649 secondary schoolchildren, with similar numbers of boys and girls. The primary schoolchildren who travelled to school by motorbike, car or bus had better grades for all the selected school subjects (p ≤ 0.009) than those who walked or cycled. No significant associations were found for secondary schoolchildren, except for mathematics and their grade point averages. All models were adjusted for sex, age and school.

CONCLUSION

Active commuting to school was inversely associated with academic achievement in primary school students but not those at secondary school. Longitudinal and intervention studies are needed to further understand our findings.