Relation of risk factors between metabolic syndrome and nonalcoholic fatty liver disease in children and adolescents

Czech version

Authors: Vratislav Smolka ¹; Jiří Ehrmann Jr. ²; Oksana Tkachyk ¹; Martin Zápalka ¹
Authors‘ workplace: Dětská klinika, Lékařská fakulta UP a FN, Olomouc ¹; Ústav klinické a molekulární patologie, Lékařská fakulta UP a FN, Olomouc ²
Published in: Čas. Lék. čes. 2014; 152: 91-97
Category: Original Article

Overview

Aim.
In recent years, nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MS) in children have increased in line with the increased prevalence of obesity. The aim of this retrospective study was to evaluate a relation between NAFDL and MS in children.

Methods.
NAFLD was defined as an elevation of serum transaminase level and hyperechogenic feature of liver on ultrasonography. MS definition was based on the diagnostic criteria of the International Diabetes Federation. The biopsies were done in patients with elevated transaminase levels lasting more than one year. Liver biopsy features were graded according to the NAFLD activity scoring (NAS) and Paediatric NAFLD Histological Score (PNHS).

Results.
NAFLD was diagnosed in 39 patients and MS was confirmed in 20 patients. The significant differences between patients with MS and without MS were found in the insulin resistance (IR) (P < 0,001), cholesterol levels (P < 0,04) and GGT levels (P < 0,05). Biopsies were done in 20 patients. MS was present in 10 children. No difference was found in the degree of steatosis and NAS in groups with and without MS. No differences were observed in the occurrence of MS diagnostic criteria between patients with and without nonalcoholic steatohepatitis which were evaluated by PNHS.

Conclusion.
Prediction factors for NAFLD are obesity, IR, dyslipidemia. NAFLD is frequently associated with MS. Liver biopsy is necessary for determination of NAFLD histological activity because no non-invasive examination defines the degree of liver pathology.

Keywords:
nonalcoholic fatty liver disease – nonalcoholic steatohepatitis – metabolic syndrome – insulin resistence – portal inflammation

Sources

1. Schwimmer JB, Behling C, Newbury R, Deutsch R, Nievergelt C, Schork NJ, Lavine JE. Histopathology of pediatric nonalcoholic fatty liver disease. Hepatology 2005; 42: 641–649.

2. Nobili V, Marcellini M, Devito R, Ciampalini P, Piemonte F, Compar-cola D, et al. NAFLD in children: A prospective clinical-pathological study and effect of lifestyle advise. Hepatology 2006; 44: 458–465.

3. Park HS, Han JH, Choi KM, et al. Relation between elevated serum alanine aminotransferase and metabolic syndrome in Korean adolescents. Am J Clin Nutr 2005; 82: 1046–1051.

4. Schwimmer JB, Pardee PE, Lavine JE, et al. Cardiovascular risk factors and the metabolic syndrome in pediatric nonalcoholic fatty liver disease. Circulation 2008; 118: 277–283.

5. Bláha P, Vígnerová J, Riedlová J, Kobzová J, Krejčovský L. VI. celostátní antropologický výzkum dětí a mládeže 2001. Čes.-slov. Pediat. 2003; 58 (12): 766–770.

6. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, Wong G, Bennett P, Shaw J, Caprio S. Metabolic syndrome in children and adolescents – an IDF konsensus report. Pediatr Diabetes 2007; 8: 299–306.

7. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Kortison J, Sherwin RS, Caprio S. Obesity and the metabolic syndrome in children and adolescents. NEJM 2004; 350: 2362–2374.

8. Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 1999; 94: 2467–2474.

9. Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, Ferrell LD, Liu YC, Torbenson MS, Unalp-Arida A, Yeh M, McCullough AJ, Sanyal AJ. Nonalcoholic Steatohepatitis Clinical Research Network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005; 41: 1313–1321.

10. Alkhouri N, De Vito R, Alisi A, Yerian L, Lopez R, Feldstein AE,Nobili V. Development and validation of a new histological score for pediatric non-alcoholic fatty liver disease. J Hepatol 2012; 57: 1312–1318.

11. Siegelman ES, Rosen MA. Imaging of hepatic steatosis. Semin Liver Dis 2001; 21: 71–80.

12. Franzese A, Vajro P, Argenziano A, Puzziello A, Iannucci MP, Saviano MC, Brunetti F, Rubino A. Liver involment in obese children. Ultrasonography and liver enzyme levels at diagnosis and during follow-up in an Italian population. Dig Dis Sci 1997; 42: 1428–1432.

13. Schwimmer JB, Deutsch R, Rauch JB, Behling C, Newbury R,Lavine JE. Obesity, insulin resistence and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease. J Pediatr 2003; 143: 500–505.

14. Mager DR, Roberts EA. Nonalcoholic fatty liver disease in children. Clin Liver Dis 2006; 10: 109–131.

15. Lonardo A, Carani C, Carulli N, Loria P. „Endocrine NAFLD“ a hormonocentric perspective of nonalcoholic fatty liver dinase pathogenesis.J Hepatol 2006; 44: 1196–1207.

16. Ford ES, Li C. Defining the metabolic syndrome in children and adolescents: will the real definition please stand up? J Pediatr 2008; 152: 160–164.

17. Marinov Z, Pastucha D. a kol. Praktická dětská obezitologie. Praha: Grada Publishing 2012.

18. Manco M, Marcellini M, Devito R, et al. Metabolic syndrome and liver histology in paediatric non-alcoholic steatohepatitis. Int J Obes (Lond) 2008; 32: 381–387.

19. Pastucha D, Filipčíková R, Horáková D, Radová L, Marinov Z, Malinčíková J, Kocvrlich M, Horák S, Bezdičková M, Dobiáš M. The incidence of metabolic syndrome in obese Czech children: the importance of early detection of insulin resistance using homeostatic indexes HOMA-IR and QUICKI. Physiol Res 2013; 62: 277–283.

20. Patton HM, Lavine JE, Van Natta ML, Schwimmer JB, Kleiner D, Molleston J and the Nonalcoholic Steatohepatitis Clinical Research Network. Clinical correlates of histopathology in pediatric nonalcoholic steatohepatitis. Gastroenterology 2008; 135: 1961–1971.

21. Day CP, James OF. Steatohepatitis: a tale of two “hits”? Gastroenterology 1998; 114: 842–845.

22. Kang H, Greenson JK, Omo JT, et al. Metabolic syndrome is associated with greater histologic severity, higher carbohydrate, and lower fat diet in patients with NAFLD. Am J Gastroenterol 2006; 101: 2247–2253.

23. Ryan MC, Wilson AM, Slavin J, et al. Associations between liver histology and severity of the metabolic syndrome in subjects with nonalcoholic fatty liver disease. Diabetes Care 2005; 28: 1222–1224.

24. Patton MH, Yates K, Unalp-Arida A, Behling CA, Huang TT, Ro-senthal P, Sanyal AJ, Schwimmer JB, Lavine JE and the NASH CRN. Association between metabolic syndrome and liver histology among children with nonalcoholic fatty liver dinase. Am J Gastroenterol 2010; 105: 2093–2102.

25. Brunt EM, Kleiner DE, Wilson LA, Unalp A, Behling CE, Lavine JE, Neuschwander-Tetri BA and the NASH Clinical Research Network. Portal chronic Inflammation in Nonalcoholic Fatty liver dinase (NAFLD): A histological Marker of Advanced NAFLD – clinicopathological correlations from the Nonalcoholic steatohepatitis Clinical Research Network. Hepatology 2009; 49: 809–920.

26. Molleston JP, White F,Teckman J, Fitzgerald JF. Obese children with steatohepatitis can develop cirrhosis in childhood. Am J Gastroenterol 2002; 97: 2460–2462.

27. Carter-Kent C, Yerian LM, Brunt EM, Angulo P, Kohli R, Ling SC, Xanthakos SA, Whitington PF, Charatcharoenwitthaya P, Yap J, Lopez R, McCullough AJ, Feldstein AE. Nonalcoholic steatohepatitis in children: A multicenter clinicopathological study. Hepatology 2009; 50: 1113–1120.

28. Feldstein AE, Charatcharoenwitthaya P, Treeprasertsuk S,Benson JT,Enders FB, Angulo P. The natural history of non-alcoholic liver dinase in children: a follow-up study for up to 20 years. Gut 2009; 58: 1538–1544.

29. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Kortison J, Sherwin RS, Caprio S. Obesity and the metabolic syndrome in children and adolescents. NEJM 2004; 350: 2362–2374.

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Article was published in

Journal of Czech Physicians

2014 Issue 2

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