ABSTRACT
To study the prevalence of metabolic syndrome [MS], insulin resistance [IR] and non-alcoholic fatty liver disease [NAFLD] in overweight/obese children with clinical hepatomegaly and/or raised alanine aminotransferase [ALT]. Thirty-three overweight and obese children, aged 2-13 years, presenting with hepatomegaly and/or raised ALT, were studied for the prevalence of MS, IR and NAFLD. Laboratory analysis included fasting blood glucose, serum insulin, serum triglycerides [TG], total cholesterol, high-density lipoprotein cholesterol [HDL-c], low-density lipoprotein cholesterol [LDL-c] and liver biochemical profile, in addition to liver ultrasound and liver biopsy. Twenty patients [60.6%] were labeled with MS. IR was present in 16 [48.4%]. Fifteen [44%] patients had biopsy-proven NAFLD. Patients with MS were more likely to have NAFLD by biopsy [P=0.001]. Children with NAFLD had significantly higher body mass index, waist circumference, ALT, total cholesterol, LDL-c, TG, fasting insulin, and lower HDL-c compared to patients with normal liver histology [P<0.05] and fitted more with the criteria of MS [80% vs. 44%]. IR was significantly more common among NAFLD patients [73% vs. 28%]. There is a close association between obesity, MS, IR and NAFLD. Obese children with clinical or biochemical hepatic abnormalities are prone to suffer from MS, IR and NAFLD
ABSTRACT
Pediatric non-alcoholic fatty liver disease [NAFLD] is a global problem which has been increasingly recognized with the dramatic rise in pediatric obesity. The aim of the present study was to identify the clinical, sonographic, and biochemical predictors for NAFLD in obese children. Seventy-six children [2-15 years] were included after an informed consent. All were subjected to full anthropometric assessment [including height, weight, body mass index, subscapular skin fold thickness, waist and hip circumference and calculation of waist: hip ratio], biochemical assessment of liver function tests, lipid profile and insulin: Sixteen patients [21%] had elevated ALT and 6 [7.9%] had elevated AST. Significant dyslipidemia [low HDL-c, high total cholesterol, high LDL-c and triglycerides] and higher insulin resistance were found in obese patients [P<0.01]. The main sonographic findings were hepatomegaly in 20 patients [26.3%] and echogenic liver in 41 patients [53.9%]. Liver biopsy showed simple steatosis in eight cases [24.2%] and non-alcoholic steatohepatitis [NASH] in seven cases [21.2%]. Anthropometric measurements, increased hepatic echogenicty by ultrasound, insulin resistance and lipid profile were good predictors of NAFLD in obese children if assessed together. However, LDL-c was the only sensitive predictor [independent variable] for NAFLD in both uni- and multivariate logistic regression analyses. Dyslipidemia per se is a strong predictor of NAFLD among obese Egyptian children