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Órgano Oficial de la Asociación Mexicana de Hepatología

2016, Number 6

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Ann Hepatol 2016; 15 (6)

Most overweight and obese Indian children have nonalcoholic fatty liver disease

Pawar SV, Zanwar VG, Choksey AS, Mohite AR, Jain SS, Surude RG, Contractor QQ, Rathi PM, Verma RU, Varthakavi PK

Language: English
References: 37
Page: 853-861
PDF size: 169.43 Kb.


ABSTRACT

Background and rationale. Nonalcoholic fatty liver disease (NAFLD) is the most common cause of pediatric liver disease in western countries. Its prevalence in Indian subcontinent is not well studied. Material and methods. In a school based cross sectional study we have screened overweight and obese children in the age group of 11 to 15 years for NAFLD. Ultrasonography, elevated serum transaminases, fibroscan were used for defining NAFLD. Dietary habits, blood pressure, serum lipid profile, blood counts and insulin resistance were recorded. The relation of fibrosis 4 score, pediatric NAFLD fibrosis index, aspartate transaminases to platelet ratio index (APRI) with fibroscan was evaluated. Results. Out of 616 students screened 198 were overweight and obese. Hundred students and their parents gave informed consent for the further evaluation. The prevalence of NAFLD was 62% in overweight and obese children. Fatty liver was found in 50 % students on ultrasonography, liver stiffness (≥ 6.1 Kilopascals) in 23% and raised alanine transaminase in 30%. Hypertension, dyslipidemia, diabetes mellitus and insulin resistance were seen in 6%, 18%, 2% and 66% students respectively. Systolic hypertension, serum triglyceride, aspartate transaminase, APRI was significantly higher in the NAFLD group. On binary logistic regression only systolic hypertension was an independent risk factor for NAFLD. Conclusion. In conclusion NAFLD is common in asymptomatic overweight and obese Indian children. Systolic hypertension is the only independent factor associated with NAFLD. Fibroscan has limited role for screening. We recommend screening for NAFLD in this high risk group with alanine transaminases and ultrasonography.


REFERENCES

  1. Masarone M, Federico A, Abenavoli L, Loguercio C, Persico M. Non-alcoholic fatty liver: epidemiology and natural history. Rev Recent Clin Trials 2014; 9: 126-33.

  2. Shneider BL, Gonzalez-Peralta R, Roberts EA. Controversies in the management of pediatric liver disease: Hepatitis B, C and NAFLD: Summary of a single topic conference. Hepatology 2006; 44: 1344-54.

  3. Pacifico L, Poggiogalle E, Cantisani V, Menichini G, Ricci P, Ferraro F, Chiesa C. Pediatric nonalcoholic fatty liver disease: A clinical and laboratory challenge. World J Hepatol 2010; 2: 275-88.

  4. Abenavoli L, Beaugrand M. Transient elastography in non-alcoholic fatty liver disease. Ann Hepatol 2012; 11: 172-8.

  5. Khadilkar VV, Khadilkar AV, Borade AB, Chiplonkar SA. Body mass index cut-offs for screening for childhood overweight and obesity in Indian children. Indian Pediatr 2012; 49: 29-34.

  6. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240-3.

  7. Yang HR, Kim HR, Kim MJ, Ko JS, Seo JK. Noninvasive parameters and hepatic fibrosis scores in children with nonalcoholic fatty liver disease. World J Gastroenterol 2012; 18: 1525-30.

  8. Nobili V, Alisi A, Vania A, Tiribelli C, Pietrobattista A, Bedogni G. The pediatric NAFLD fibrosis index: a predictor of liver fibrosis in children with non-alcoholic fatty liver disease. BMC Med 2009; 7: 21.

  9. de Lédinghen V, Le Bail B, Rebouissoux L, Fournier C, Foucher J, Miette V, Castéra L, et al. Liver stiffness measurement in children using FibroScan: feasibility study and comparison with Fibrotest, aspartate transaminase to platelets ratio index, and liver biopsy. J Pediatr Gastroenterol Nutr 2007; 45: 443-50.

  10. Marzuillo P, Grandone A, Perrone L, Miraglia Del Giudice E. Controversy in the diagnosis of pediatric non-alcoholic fatty liver disease. World J Gastroenterol 2015; 21: 6444-50.

  11. Prati D, Taioli E, Zanella A, Della Torre E, Butelli S, Del Vecchio E, Vianello L, et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med 2002; 137: 1-10.

  12. Schwimmer JB, Dunn W, Norman GJ, Pardee PE, Middleton MS, Kerkar N, Sirlin CB. SAFETY study: alanine aminotransferase cutoff values are set too high for reliable detection of pediatric chronic liver disease. Gastroenterology 2010; 138: 1357-64.

  13. Yajima Y, Ohta K, Narui T, Abe R, Suzuki H, Ohtsuki M. Ultrasonographic diagnosis of fatty liver: significance of the liver– kidney contrast. Tohoku J Exp Med 1983; 139: 43-50.

  14. Fitzpatrick E, Quaglia A, Vimalesvaran S, Basso MS, Dhawan A. Transient elastography is a useful noninvasive tool for the evaluation of fibrosis in paediatric chronic liver disease. J Pediatr Gastroenterol Nutr 2013; 56: 72-6.

  15. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114: 555-76.

  16. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, Wong G, et al; IDF Consensus Group. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes 2007; 8: 299-306.

  17. Xanthakos SA, Jenkins TM, Kleiner DE, Boyce TW, Mourya R, Karns R, Brandt ML, et al. High Prevalence of Nonalcohol ic Fatty Liver Disease in Adolescents Undergoing Bariatric Surgery. Gastroenterology 2015; 149: 623-34.

  18. Chaturvedi K, Vohra P. Non-alcoholic fatty liver disease in children. Indian Pediatr 2012; 49: 757-8.

  19. Chan DF, Li AM, Chu WC, Chan MH, Wong EM, Liu EK, Chan IH, et al. Hepatic steatosis in obese Chinese children. Int J Obes Relat Metab Disord 2004; 28: 1257-63.

  20. Fu JF, Shi HB, Liu LR, Jiang P, Liang L, Wang CL, Liu XY. Non-alcoholic fatty liver disease: An early mediator predicting metabolic syndrome in obese children? World J Gastroenterol 2011; 17: 735-42.

  21. Huang SC, Yang YJ. Serum retinol-binding protein 4 is independently associated with pediatric NAFLD and fasting triglyceride level. J Pediatr Gastroenterol Nutr 2013; 56: 145-50.

  22. Arslan N, Büyükgebiz B, Oztürk Y, Cakmakçi H. Fatty liver in obese children:prevalence and correlation with anthropometric measurements and hyperlipidemia. Turk J Pediatr 2005; 47: 23-7.

  23. Louthan MV, Theriot JA, Zimmerman E, Stutts JT, McClain CJ. Decreased prevalence of nonalcoholic fatty liver disease in black obese children. J Pediatr Gastroenterol Nutr 2005; 41: 426-9.

  24. Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of fatty liver in children and adolescents. Pediatrics 2006; 118: 1388-93.

  25. Nobili V, Reale A, Alisi A, Morino G, Trenta I, Pisani M, Marcellini M, et al. Elevated serum ALT in children presenting to the emergency unit: Relationship with NAFLD. Dig Liver Dis 2009; 41: 749-52.

  26. Reinehr T, Toschke AM. Onset of puberty and cardiovascular risk factors in untreated obese children and adolescents: a 1-year follow-up study. Arch Pediatr Adolesc Med 2009; 163: 709-15.

  27. Gupta R, Bhangoo A, Matthews NA, Anhalt H, Matta Y, Lamichhane B, Malik S, et al. The prevalence of non-alcoholic fatty liver disease and metabolic syndrome in obese children. J Pediatr Endocrinol Metab 2011; 24: 907-11.

  28. Nehal M. El-Koofy, Ghada M. Anwar, Mona S. El-Raziky, Ahmad M. El-Hennawy, Fatma M. El-Mougy, Hanaa M. El-Karaksy, Fetouh M. Hassanin, et al. The Association of Metabolic Syndrome, Insulin Resistance and Non-alcoholic Fatty Liver Disease in Overweight/Obese Children. Saudi J Gastroenterol 2012; 18: 44-9.

  29. Papandreou D, Karabouta Z, Pantoleon A, Rousso I. Investigation of anthropometric, biochemical and dietary parameters of obese children with and without non-alcoholic fatty liver disease. Appetite 2012; 59: 939-44.

  30. Zhang X, Wan Y, Zhang S, Lu L, Chen Z, Liu H, Jiang X, et al. Nonalcoholic fatty liver disease prevalence in urban school-aged children and adolescents from the Yangtze River delta region: a cross-sectional study. Asia Pac J Clin Nutr 2015; 24: 281-8.

  31. Oliveira AM, Oliveira N, Reis JC, Santos MV, Silva AM, Adan L. Triglycerides and alanine aminotransferase as screening markers for suspected fatty liver disease in obese children and adolescents. Horm Res 2009; 71: 83-8.

  32. Schwimmer JB, McGreal N, Deutsch R, Finegold MJ, Lavine JE. Influence of gender, race, and ethnicity on suspected fatty liver in obese adolescents. Pediatrics 2005; 115: e561- e565.

  33. Wiegand S, Keller KM, Röbl M, L’Allemand D, Reinehr T, Widhalm K, Holl RW;APV-Study Group and the German Competence Network Adipositas. Obese boys at increased risk for nonalcoholic liver disease: evaluation of 16,390 overweight or obese children and adolescents. Int J Obes (Lond) 2010; 34: 1468-74.

  34. Park HS, Han JH, Choi KM, Kim SM. Relation between elevated serum alanine aminotransferase and metabolic syndrome in Korean adolescents. Am J Clin Nutr 2005; 82: 1046-51.

  35. Strauss RS, Barlow SE, Dietz WH. Prevalence of abnormal serum aminotransferase values in overweight and obese adolescents. J Pediatr 2000; 136: 727-33.

  36. Alavian SM, Mohammad-Alizadeh AH, Esna-Ashari F, Ardalan G, Hajarizadeh B. Non-alcoholic fatty liver disease prevalence among school-aged children and adolescents in Iran and its association with biochemical and anthropometric measures. Liver Int 2009; 29: 159-63.

  37. Feldstein AE, Charatcharoenwitthaya P, Treeprasertsuk S, Benson JT, Enders FB, Angulo P. The natural history of nonalcoholic fatty liver disease in children: a follow-up study for up to 20 years. Gut 2009; 58: 1538-44.




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