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Screening for non-alcoholic fatty liver disease among obese and overweight children: Prevalence and predictors

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Abstract

Background

Non-alcoholic fatty liver disease (NAFLD) is increasingly recognized in obese and overweight children. NAFLD is the commonest cause of chronic liver disease in these children. We undertook a study to assess the prevalence of NAFLD and to identify the associated anthropometric and metabolic risk factors.

Methods

This cross-sectional study was done with 154 overweight and obese children. The study population was divided into 2 groups based on the presence or absence of NAFLD by screening with ultrasonography and/or alanine transaminase levels. Anthropometric (body mass index [BMI], waist circumference) and biochemical parameters (triglyceride, high density lipoprotein, low density lipoprotein, very low density lipoprotein, total cholesterol, insulin, homeostasis model assessment of insulin resistance [HOMA-IR], alanine transaminase, aspartate transaminase) were compared between these two groups.

Results

NAFLD was diagnosed based on abnormal screening in 79 (51.3%) overweight and obese children. No age or gender difference was noted between the 2 groups. There were no significant differences in BMI, systolic blood pressure, diastolic blood pressure, and waist circumference between patients with and without NAFLD. Low-density lipoprotein (LDL) cholesterol levels were found significantly higher in the NAFLD group. There was no significant difference in lipid profile apart from LDL cholesterol, aspartate transaminase, and HOMA-IR between the 2 groups.

Conclusion

NAFLD is common in overweight and obese southern Indian children. High LDL cholesterol level is a risk factor for NAFLD in these children. Screening of this high-risk group for early diagnosis of NAFLD is essential to prevent and monitor further progression of the disease.

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References

  1. Bhave S, Bavdekar A, Otiv M, IAP National Task Force for Childhood Prevention of Adult Diseases: childhood obesity. IAP National Task Force for Childhood Prevention of Adult Diseases: Childhood Obesity. Indian Pediatr. 2004;41:559–75.

    PubMed  Google Scholar 

  2. Halfon N, Kandyce L, Slusser W. Associations between obesity and comorbid mental health, developmental, and physical health conditions in a nationally representative sample of US children aged 10 to 17. Acad Pediatr. 2013;13:6–13.

    Article  Google Scholar 

  3. Lloyd LJ, Langley-Evans SC, McMullen S. Childhood obesity and risk of the adult metabolic syndrome: a systematic review. Int J Obes. 2012;36:1–11.

    Article  CAS  Google Scholar 

  4. Thiagarajan S, Arun Babu T, Manivel P. Acanthosis nigricans and metabolic risk factors in obese children. Indian J Pediatr. 2020;87:162.

  5. Giorgio V, Prono F, Graziano F, Nobili V. Pediatricnon alcoholic fatty liver disease: old and new concepts on development, progression, metabolic insight and potential treatment targets. BMC Pediatr. 2013;13:40.

    Article  Google Scholar 

  6. Anderson EL, Howe LD, Jones HE, et al. The prevalence of non-alcoholic fatty liver disease in children and adolescents: a systematic review and meta-analysis. PLoS One. 2015;10:e0140908.

    Article  Google Scholar 

  7. Prokopowicz Z, Malecka-Tendera E, Matusik P. Predictive value of adiposity level, metabolic syndrome, and insulin resistance for the risk of nonalcoholic fatty liver disease diagnosis in obese children. Can J Gastroenterol Hepatol. 2018;9465784.

  8. Buzzetti E, Pinzani M, Tsochatzis EA. The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD). Metabolism. 2016;65:1038–48.

    Article  CAS  Google Scholar 

  9. Gökçe S, Atbinici Z, Aycan Z, et al. The relationship between pediatricnon alcoholic fatty liver disease and cardiovascular risk factors and increased risk of atherosclerosis in obese children. Pediatr Cardiol. 2013;34:308–15.

    Article  Google Scholar 

  10. Yıldız Y, Sivri HS. Inborn errors of metabolism in the differential diagnosis of fatty liver disease. Turk J Gastroenterol. 2020;31:3–16.

    Article  Google Scholar 

  11. Lonardo A, Ballestri S, Marchesini G, Angulo P, Loria P. Nonalcoholic fatty liver disease: a precursor of the metabolic syndrome. Dig Liver Dis. 2015;47:181-90. 

    Article  Google Scholar 

  12. Kasturiratne A, Weerasinghe S, Dassanayake AS. Influence of non-alcoholic fatty liver disease on the development of diabetes mellitus. J Gastroenterol Hepatol. 2013;28:142–7.

    Article  Google Scholar 

  13. Yoneda M, Imajo K, Takahashi H, et al. Clinical strategy of diagnosing and following patients with nonalcoholic fatty liver disease based on invasive and noninvasive methods. J Gastroenterol. 2018;53:181–96.

    Article  CAS  Google Scholar 

  14. Gu J, Liu S, Du S, et al. Diagnostic value of MRI-PDFF for hepatic steatosis in patients with non-alcoholic fatty liver disease: a meta-analysis. Eur Radiol. 2019;29:3564–73.

  15. Draijer LG, Feddouli S, Bohte AE, et al. Comparison of diagnostic accuracy of screening tests ALT and ultrasound for pediatric non-alcoholic fatty liver disease. Eur J Pediatr. 2019;178:863–70.

    Article  Google Scholar 

  16. Koplay M, Sivri M, Erdogan H, Nayman A. Importance of imaging and recent developments in diagnosis of nonalcoholic fatty liver disease. World J Hepatol. 2015;7:769–76.

    Article  Google Scholar 

  17. Vos MB, Abrams SH, Barlow SE, et al. NASPGHAN clinical practice guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children: recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr. 2017;64:319–34.

  18. Schwimmer JB, Newton KP, Awai HI, et al. Paediatric gastroenterology evaluation of overweight and obese children referred from primary care for suspected non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2013;38:1267–77.

  19. Khadilkar V, Yadav S, Agrawal KK, et al. Revised IAP growth charts for height, weight and body mass index for 5- to 18-year-old Indian children. Indian Pediatr. 2015;52:47–55.

    Article  Google Scholar 

  20. Shannon A, Alkhouri N, Carter-Kent C, et al. Ultrasonographic quantitative estimation of hepatic steatosis in children with NAFLD. J Pediatr  Gastroenterol Nutr. 2011;53:190–5.

  21. Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu M, et al. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol. 2010;2:100–6.

  22. Vajro P, Lenta S, Socha P, et al. Diagnosis of non alcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr. 2012;54:700–13.

  23. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–91.

    Article  Google Scholar 

  24. Perla FM, Prelati M, Lavorato M, Visicchio D, Anania C. The role of lipid and lipoprotein metabolism in non-alcoholic fatty liver disease. Children (Basel). 2017;4:46. 

    Google Scholar 

  25. Clemente MG, Mandato C, Poeta M, Vajro P. Pediatric non-alcoholic fatty liver disease: recent solutions, unresolved issues, and future research directions. World J Gastroenterol. 2016;22:8078–93.

    Article  Google Scholar 

  26. Dasarathy S, Dasarathy J, Khiyami A. Validity of real time ultrasound in the diagnosis of hepatic steatosis: a prospective study. J Hepatol. 2009;51:1061–7.

    Article  Google Scholar 

  27. Pawar SV, Zanwar VG, Choksey AS, et al. Most overweight and obese Indian children have nonalcoholic fatty liver disease. Ann Hepatol. 2016;15:853–61.

    CAS  PubMed  Google Scholar 

  28. Jain V, Jana M, Upadhyay B, et al. Prevalence, clinical & biochemical correlates of non-alcoholic fatty liver disease in overweight adolescents. Indian J Med Res. 2018;148:291–301.

    Article  CAS  Google Scholar 

  29. Yang HR, Chang EJ. Insulin resistance, body composition, and fat distribution in obese children with nonalcoholic fatty liver disease. Asia Pac J ClinNutr. 2016;25:126–33.

    Google Scholar 

  30. Deeb A, Attia S, Mahmoud S, Elhaj G, Elfatih A. Dyslipidemia and fatty liver disease in overweight and obese children. J Obes. 2018;2018:8626818.

  31. Alkhouri N, Eng K, Lopez R, Nobili V. Non-high-density lipoprotein cholesterol (non-HDL-C) levels in children with nonalcoholic fatty liver disease (NAFLD). Springer plus. 2014;3:407.

    Article  Google Scholar 

  32. Alkassabany YM, Farghaly AG, El-Ghitany EM. Prevalence, risk factors, and predictors of nonalcoholic fatty liver disease among schoolchildren: a hospital-based study in Alexandria. Egypt Arab J Gastroenterol. 2014;15:76–81.

    Article  Google Scholar 

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Acknowledgements

We would like to thank Mr. Durairaj Mahadevan, Department of Biochemistry, for his assistance in statistical analysis.

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Authors and Affiliations

  1. Department of Paediatrics, Indira Gandhi Medical College and Research Institute, Puducherry 605 009, India

    Srinivasan Thiagarajan

  2. Department of Radiology, Indira Gandhi Medical College and Research Institute, Puducherry 605 009, India

    Sadhanandham Shrinuvasan

  3. Department of Paediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri 522 503, India

    Thirunavukkarasu Arun Babu

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  1. Srinivasan Thiagarajan
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Contributions

ST and TAB conceived the study. ST, SS, and TAB collected data and managed the patients. ST reviewed the literature and drafted the initial version of the manuscript. All authors contributed to drafting of the manuscript and approved the final version of the manuscript. TAB shall act as guarantor of the paper.

Corresponding author

Correspondence to Thirunavukkarasu Arun Babu.

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Conflict of interest

ST, SS, and TAB declare that they have no conflict of interest.

Ethics statement

The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Ethical clearance

No 06/IEC/IGMC&RI/F-7/2018

Ethical clearance

The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

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The study was conducted at Indira Gandhi Medical College and Research Institute, Puducherry.

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Thiagarajan, S., Shrinuvasan, S. & Arun Babu, T. Screening for non-alcoholic fatty liver disease among obese and overweight children: Prevalence and predictors. Indian J Gastroenterol 41, 63–68 (2022). https://doi.org/10.1007/s12664-021-01198-0

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  • DOI: https://doi.org/10.1007/s12664-021-01198-0

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