Hepatic parenchyma changes in obese paediatric patients

Download PDF Česká verzia

Authors: M. Pršo ¹ ; L. Pršová ¹; Z. Havlíčeková ¹ ; Z. Michnová ¹; M. Kozár ² ; K. Pršo ³; P. Bánovčin Jr. ⁴ ; L. Skladaný ⁵ ; Peter Bánovčin ¹
Authors place of work: Clinic of Children and Adolescents, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin ¹; Clinic of Neonatology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin ²; Department of Pharmacology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava ³; Clinic of Internal Medicine – Gastroenterology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin ⁴; 2nd Department of Internal Medicine, HEGITO, F. D. Roosevelt University Hospital Banska Bystrica ⁵
Published in the journal: Gastroent Hepatol 2023; 77(2): 112-122
Category:
doi: https://doi.org/10.48095/ccgh2023112

Summary

Rationale: Non-alcoholic fatty liver disease (NAFLD) is emerging clinical issue in childhood and adolescent age. Present knowledge of NAFLD suggests an important role of genetic and environmental risk factors in the pathogenesis of the disease. Most of the patients are obese, however, NAFLD also occurs in the non-obese group and interestingly, in obese individuals it may be absent. The transabdominal ultrasound examination is the most widely used imaging method for NAFLD screening. Aim: The aim of the study was to assess the impact of paediatric obesity as the main risk factor in NAFLD development. Materials and methods: The degree of steatosis (represented by hepatorenal index) and hepatic parenchyma stiffness (represented by fibrosis liver index) were quantitatively evaluated using ultrasound device in a total of 240 paediatric and adolescent patients divided in subgroups according to age and weight criteria. Results from ultrasound examination were subsequently correlated with anthropometric and laboratory parameters. Results: Hepatorenal index (HRI) and liver fibrosis index (LFI) in healthy term neonates with normal birth weight was significantly lower compared to the control group of healthy normal weight children aged 10–18 years (p <0.001). We did not observe an effect of gender on changes in HRI (p = 0.332) and LFI (p = 0.339) in teenage and adolescent controls. Regardless of gender, normal HRI values in paediatric heathy control group ranged from 1.02–1.23 (10^th–90^th percentile). The group of obese children aged 10–18 years had HRI and LFI values significantly higher in contrast with healthy normal weight controls. Obese individuals had liver stiffness proportional to BMI (p = 0.005, r_s = 0.310), however, the steatosis degree remained unchanged (p = 0.357). Hepatic parenchyma stiffness also increased with waist circumference gain in corpulent patients (p <0.01). Conclusion: Results of this study point to a significant association of obesity and NAFLD in paediatric population. The assessment of HRI and liver stiffness using ultrasound methods have been employed in the diagnosis of early stages of hepatic changes in obese children and adolescent patients at risk of NAFLD development. In addition to the early detection in these changes, ultrasound determination enables non-invasive and real-time assessment of dynamics of the disease and the effect of the administered therapy, which improves control over the disease.

Keywords:

obesity – non-alcoholic fatty liver disease – paediatric age – hepatorenal index – real-time elastography – body roundness index – adolescent age

Zdroje

1. Bodzsar EB, Zsakai A. Recent trends in childhood obesity and overweight in the transition countries of Eastern and Central Europe. Ann Hum Biol 2014; 41 (3): 263–270. doi: 10.3109/ 03014460.2013.856473.

2. WHO. Obesity and overweight. 2021 [online]. Dostupné z: http: //who.int/mediacentre/fact sheets/fs311/en/.

3. Cole TJ, Bellizzi MC, Flegal KM et al. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320 (7244): 1240–1243. doi: 10.1136/bmj.320.7244.1240.

4. Thomas DM, Bredlau C, Bosy-Westphal A et al. Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model. Obesity (Silver Spring) 2013; 21 (11): 2264–2271. doi: 10.1002/ oby.20408.

5. Webb M, Yeshua H, Zelber-Sagi S et al. Diag- nostic value of a computerized hepatorenal index for sonographic quantification of liver steatosis. AJR Am J Roentgenol 2009; 192 (4): 909–914. doi: 10.2214/AJR.07.4016.

6. Kohli R, Sunduram S, Mouzaki M et al. Pediatric nonalcoholic fatty liver disease: a report from the expert committee on nonalcoholic fatty liver disease (ECON). J Pediatr 2016; 172: 9–13. doi: 10.1016/j.jpeds.2015.12.016.

7. Akcam M, Boyaci A, Pirgon O et al. Importance of the liver ultrasound scores in pubertal obese children with nonalcoholic fatty liver disease. Clin Imaging 2013; 37 (3): 504–508. doi: 10.1016/j.clinimag.2012.07.011.

8. Hamaguchi M, Kojima T, Itoh Y et al. The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation. Am J Gastroenterol 2007; 102 (12): 2708–2715. doi: 10.1111/j.1572-0241.2007.01526.x.

9. Duarte MA, Silva GA. Hepatic steatosis in obese children and adolescents. J Pediatr 2011; 87 (2): 150–156. doi: 10.2223/JPED.2065.

10. Vajro P, Lenta S, Socha P et al. Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr 2012; 54 (5): 700–713. doi: 10.1097/MPG.0b013e318252a13f.

11. Manco M, Bedogni G, Marcellini M et al. Waist circumference correlates with liver fibrosis in children with non-alcoholic steatohepatitis. Gut 2008; 57 (9): 1283–1287. doi: 10.1136/gut. 2007.142919.

12. Motamed N, Rabiee B, Hemasi GR et al. Body Roundness Index and Waist-to-Height Ratio are Strongly Associated with Non-Alcoholic Fatty Liver Disease: A Population-Based Study. Hepat Mon 2016; 16 (9): e39575. doi: 10.5812/hepatmon.39575.

13. Michnová Z, Szépeová R, Havlíčeková Z et al. Prevalencia hepatopatie u adolescentov s diabetes mellitus 1. typu. Pediatria (Bratisl.) 2017; 12 (2): 53.

14. Saadeh S, Younossi ZM, Remer EM et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 2002; 123 (3): 745–750. doi: 10.1053/gast.2002.35 354.

15. 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 (2): 190–195. doi: 10.1097/MPG.0b013e31821b4b61.

16. Borges VF, Diniz AL, Cotrim HP et al. Sonographic hepatorenal ratio: a noninvasive method to diagnose nonalcoholic steatosis. J Clin Ultrasound 2013; 41 (1): 18–25. doi: 10.1002/jcu.21 994.

17. Ayonrinde OT, Oddy WH, Adams LA et al. Infant nutrition and maternal obesity influence the risk of non-alcoholic fatty liver disease in adolescents. J Hepatol 2017; 67 (3): 568–576. doi: 10.1016/j.jhep.2017.03.029.

18. Thompson AL. Intergenerational impact of maternal obesity and postnatal feeding practices on pediatric obesity. Nutr Rev 2013; 71 (1): S55–S61. doi: 10.1111/nure.12054.

19. Ferraioli G, Calcaterra V, Lissandrin R et al. Noninvasive assessment of liver steatosis in children: the clinical value of controlled attenuation parameter. BMC Gastroenterol 2017; 17 (1): 61. doi: 10.1186/s12876-017-0617-6.

20. Bailey SS, Youssfi M, Patel M et al. Shear-wave ultrasound elastography of the liver in normal-weight and obese children. Acta Radiologica 2017; 58 (12): 1511–1518. doi: 10.1177/0 284185117695668.

21. Cho Y, Tokuhara D, Morikawa H et al. Transient Elastography-Based Liver Profiles in a Hospital-Based Pediatric Population in Japan. PLoS One 2015; 10 (9): e0137239. doi: 10.1371/journal.pone.0137239.

22. Fishbein MH, Miner M, Mogren C et al. The spectrum of fatty liver in obese children and the relationship of serum aminotransferases to severity of steatosis. J Pediatr Gastroenterol Nutr 2003; 36 (1): 54–61. doi: 10.1097/00005176- 200301000-00012.

23. Havlíčeková Z, Szépeová R, Zubríková L et al. Význam črevnej mikroflóry v etiopatogenéze nealkoholovej steatózy pečene. Čes-slov Pediat 2015; 70 (1): 11–16.

24. Schwimmer JB, Deutsch R, Kahen T et al. Prevalence of fatty liver in children and adolescents. Pediatrics 2006; 118 (4): 1388–1393. doi: 10.1542/peds.2006-1212.

25. Baker L, Farpour-Lambert JN, Nowicka P et al. Vyšetrenie dieťaťa s nadváhou/obezitou- praktické rady pre primárnu lekársku starostlivosť: odporúčania od childhood obesity task force európskejobezitologickej spoločnosti (AESO). Pediatria (Bratisl.) 2012; 7 (5): 229–234.

26. Račanská E. Vitamín D – hormón, ktorý nám chýba. Prakt. lekárn 2014; 4 (2–3): 53–55.

27. Black LJ, Jacoby P, She Ping-Delfos WC et al. Low serum 25-hydroxyvitamin D concentracions associate with non-alcoholic fatty liver disease in adolescents independent of adiposity. J Gastroenterol Hepatol 2014; 29 (6): 1215–1222. doi: 10.1111/jgh.12541.