ABSTRACT
La enfermedad de hígado graso no alcohólico (EHGNA) se manifiesta con daño hepático y se asocia a la obesidad. El objetivo fue detectar en escolares obesos el riesgo para desarrollar EHGNA, a través de un estudio observacional analítico, comparando el funcionalismo hepático con un grupo control y su relación con variables antropométricas, bioquímicas, dietéticas y actividad física. Se evaluaron en 160 escolares (7-11 años) la condición socioeconómica, el estado nutricional por el índice de masa corporal (IMC), área grasa (AG) del brazo (Proyecto Venezuela 1994), porcentaje de grasa corporal por antropometría (% GC), circunferencia de cintura (CC), tolerancia oral a la glucosa, insulinemia basal y postcarga de glucosa, CT, cLDL, cVLDL, cHDL, triglicéridos (TG), TGO, TGP, gammaglutamiltranspeptidasa (GGTP) y albúmina. La dieta se analizó por el recordatorio de 24 horas y la actividad física por una prueba clínica. En 88 escolares obesos se observaron mayores promedios (p<0,05) de TGP, mayor frecuencia (p<0,05) de TGO y TGP elevadas y de albúmina baja (p<0,05), que en los controles. La TGP se correlacionó significativamente con el IMC, AG, % GC, CC, insulina basal y postcarga de glucosa, HOMA, cVLDL, cHDL y TG, mientras que la TGO con el AG y la GGTP con AG, insulina basal, HOMA y cLDL. La albúmina se correlacionó negativamente con el IMC, AG, % GC y CC. La TGP fue la que más reflejó el compromiso hepático de la obesidad. Para evaluar el riesgo de EHGNA, se debe estandarizar los valores de TGO/TGP según edad, género y raza.
The non alcoholic fatty liver disease (NAFLD) manifests with liver damage and it is associated with obesity. The objective of this work was to detect the risk of obese school students of developing NAFLD, through an analytical, observational study, comparing their liver function with that of a control group, and its relationship with physical activity, dietary, biochemical and anthropometric variables. One hundred and sixty school students (ages 7-11) were evaluated according to their socio-economic status; nutritional status by the body mass index (BMI) and mid-upper arm fat area (MUAC) (Project Venezuela 1994); body fat percentage by anthropometry (% BF), waist circumference (WC); and metabolism by oral glucose tolerance, basal insulin and post-load glucose, total cholesterol (TC), cLDL, cVLDL, cHDL, triglycerides (TG), glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), gamma glutamil transpeptidasa (GGTP) and albumin. Their diet was analyzed by the 24-hour recall and their physical activity by a clinical trial. Mean levels of GPT (p < 0.05), greater frequencies of elevated GOT and GPT (p < 0.05) and lower albumin levels (p < 0.05) were observed in 88 obese school students when compared to controls. The GPT correlated significantly with the BMI, MUAC, % BF, WC, basal insulin and post-load glucose, HOMA, cVLDL, cHDL and TG, while the GOT correlated with MUAC and the GGTP with MUAC, basal insulin, HOMA and cLDL. Albumin was negatively correlated with BMI, MUAC, % BF and WC. TGP reflected better the hepatic compromise of obesity. To assess the risk of NAFLD, the TGO/TGP values should be standardized according to age, gender and race.
Subject(s)
Child , Female , Humans , Male , Pediatric Obesity/physiopathology , Cross-Sectional Studies , Liver Function TestsABSTRACT
Blood tests such as aminotransferases are indicators of liver cell injury not liver function, so it would be more appropriate to call them liver tests instead of liver function tests. Liver tests should be interpreted in a clinical context, and follow-up tests are often helpful to assess liver diseases. Abnormal liver tests in apparently healthy individuals can be categorized into four types: (1) isolated elevation of serum bilirubin; (2) isolated elevation of serum alkaline phosphatase (ALP); (3) hepatocellular injury; and (4) intrahepatic cholestasis. Mild unconjugated hyperbilirubinemia without any other test results is frequently suggestive of Gilbert syndrome, which needs no specific therapy, but the possibility of hemolysis should be ruled out. An isolated elevation of ALP can be due to non-hepatic causes such as normal rapid growth, pregnancy, or bone diseases. The source of the elevated ALP can be considered to be of hepatic origin if gamma-glutamyl transpeptidase (GGT) increases simultaneously. GGT also increases after chronic ethanol ingestion. A significant elevation of ALP also occurs in infiltrative lesions of lymphoma or leukemia. Up to 25% of asymptomatic testees show a mild elevation of aminotransferases. A substantial proportion of them have parenchymal liver diseases such as fatty liver, chronic hepatitis, or early cirrhosis. A history of exposure to hepatotoxins, physical examination, and tests for viral markers are helpful. If ALT is normal, the increased AST is highly likely to be of muscle origin. Serum ALP and GGT increase mainly in intrahepatic cholestasis, and early stage of primary biliary cirrhosis or drug-induced cholestasis should be considered.