Is there any association between high-density lipoprotein, insulin resistance and non-alcoholic fatty liver disease in obese children?

Non-alcoholic fatty liver disease (NAFLD) is estimated to occur in about 50% of obese children. The purpose of this study is to examine the association of anthropometric, biochemical and liver indexes in obese children with and without NAFLD and its relation with insulin resistance (IR). Forty-three obese children participated in the study. NAFLD was diagnosed by ultrasonography. Liver indices (SGOT, SGPT), lipid profile, glucose and insulin levels were performed in all patients. IR was measured by means of the homeostasis model assessment and oral glucose insulin sensitivity. Among the 43 obese patients, 18/43 (41.8%) had NAFLD based on ultrasonography. Fifty percent of them had mild steatosis and 50% had moderate/severe steatosis. In logistic regression analysis of factors associated with NAFLD, homeostasis model assessment IR (ExpB, 1.607; 95% confidence interval, 1.058-2.440; P <0.02) and high-density lipoprotein (0.952; 95% confidence interval, 0.814-1.075; P <0.03) were the most significant. IR, as has already been proved, is associated with NAFLD. Furthermore, high-density lipoprotein levels seem to play an additional role in predicting NAFLD in obese children.

Are saturated fatty acids and insulin resistance associated with fatty liver in obese children?

BACKGROUND: Fatty liver (FL) is a common cause of liver disease in children. Obesity and insulin resistance (IR) play an important role in pathogenesis of FL. Diet has been reported to affect IR and possibly FL. The purpose of this study was to investigate certain parameters (anthropometric, biochemical, dietary intake) of obese Greek children with and without FL. METHODS: Forty-three obese children aged 9-14 (25 boys/18 girls) participated in the study. FL was diagnosed by ultrasonography (US). Liver indexes (ALT, AST, gamma-GT) were measured in all children. A 3-day dietary was recorded for all subjects. None of the subjects were positive for viral hepatitis or had a history of consuming alcohol. RESULTS: Eighteen out of 43 subjects (41.8%) had FL based on US. Intakes of carbohydrates and simple refined carbohydrates were significantly higher in subjects with FL compared to children without FL, while saturated fatty acids (SFA) were proportionally increased to the degree of hepatic steatosis. In multiple regression analysis of factors associated with FL, only HOMA-IR [Beta: 0.160, 95%CI (0.122-1.340), P<0.001] and SFA [Beta: 0.455, 95%CI (0.129-2.129), P<0.001] were the most significant one. CONCLUSIONS: Our results suggest that high intake of carbohydrates and simple refined carbohydrates as well as low intake of fiber may be correlated with the pathogenesis of FL. Moreover, IR and high intake of SFA are independently associated with FL in obese children.

Update on non-alcoholic fatty liver disease in children.

Non-alcoholic fatty liver disease (NAFLD) is probably the most common cause of liver disease in the pediatric community. It is closely associated with obesity and insulin resistance. NAFLD may lead to non-alcoholic steatohepatitis (NASH). Although NASH is a prerequisite for the definition of NAFLD in adults and children, distinct differences are often apparent in the extent or location of fat, inflammation and fibrosis. Confirmation of the diagnosis of NAFLD can usually be achieved by imaging studies; however, staging the disease requires a liver biopsy. Current treatment relies on weight loss and exercise, although various insulin-sensitizing agents, antioxidants and medications appear promising. The aim of this review is to summarize what is known about pediatric NAFLD in terms of prevalence, pathogenesis, diagnosis, histology and treatment.

Total serum homocysteine, folate and vitamin B12 in a Greek school age population.

BACKGROUND & AIMS: Moderate hyperhomocysteinemia is an independent risk factor for cardiovascular disease (CVD) even among children. The purpose of this study is to investigate for the first time the distribution and determinants of total serum homocysteine (tHcy) levels in healthy Greek children. METHODS: tHcy, folate, B12 were measured in 524 children (275 boys and 249 girls) aged 6-15 years old from different socioeconomic status in Northern Greece. RESULTS: The geometric mean tHcy level for boys and girls was 7.8 (3.4-24.2) and 7.5 (3.9-29.0) micromol/L, respectively. Eighty one (15.4%) children had homocysteine levels above the upper reference limits (>10 micromol/L). The geometric mean serum tHcy level was significantly (P<0.001) increasing with age; 6.4 (3.4-11.2) micromol/L was found in the age group of 6-9 yr (group1), 7.2(4.1-22.1) micromol/L in the one of 10-12 yr (group 2) and 8.5 (3.9-29.0) micromol/L in the one of 13-15 yr (group 3). Serum folate levels were found to be statistically significant (P<0.001) between age group 1 and age group 3 [11.8 (4.66-20.00) vs. 7.5 (0.99-20.00)ng/mL) and between age group 2 and 3 [10.0 (1.82-20.0) vs. 7.5 (0.99-20.00)ng/mL]. Vitamin B12 levels were significantly (P<0.001) different in the three age groups [1048 (117-2000), 805 (296-2000), 700 (214-2000)pg/mL] respectively. Age, BMI, waist circumference (WC), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were positively correlated with tHcy, whereas serum folate and vitamin B12 were negatively correlated. No association was found between tHcy levels and parental education status. In multiple linear regression analysis only age (Beta: 0.248, 95%, CI: (0.159-0.361), P<0.05) and folate (Beta: 0.347, 95%, CI: [(-0.206)-(-0.118)], P<0.05) were found significantly and independently associated with tHcy. CONCLUSIONS: tHcy levels were increasing with age and boys were found to have slightly higher levels than girls. Age and folate levels were the most significantly and independently determinants associated with tHcy. Children with tHcy levels above the upper reference limits (>10 micromol/L) were found to be correlated with BMI, WC, SBP, serum folate and vitamin B12 levels. These children should be encouraged to include high folate food items in their diet and where necessary folate supplements should be recommended. In addition, more prospective studies are necessary in order to evaluate the relationship of tHcy and CVD risk factors in children of our region.