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NON ALCOHOLIC FATTY LIVER DISEASE RISK PROFILE IN A PAEDIATRIC OBESE POPULATION

2005; Lippincott Williams & Wilkins; Volume: 40; Issue: 5 Linguagem: Inglês

10.1097/00005176-200505000-00206

1536-4801

Hanna Karen Moreira Antunes, A Martins, Débora de Sousa Lemos, Carla Karoline Jesus Santos,

Diet and metabolism studies

Introduction: Non alcoholic fatty liver disease (NAFLD) covers a spectrum from static disease to more aggressive forms that can progress to cirrhosis within childhood. Aim: To determine the prevalence of NAFLD in an obese paediatric population and try to found a NAFLD risk profile. Methods: We collected all the protocol data of the patients referred to us between 1/2/1999-20/12/2004. Obese was defined as BMI > 95th percentile (P) for age and gender. Hyperinsulinism: insulin >33 μU/mL. Insulin resistance was determined using homeostasis model assessment of insulin resistance (HOMA-IR). We used the χ2, Mann-Whitney-U and t-test. Results: Of the 327 obese children and adolescents, 48.2% were male. The median age was of 10 years (range 2 to 17 years) and the mean (sd) of BMI 27.3 ± 4.3 with 6.7 % having BMI > 35. At 3 months follow-up, the BMI decreased to 26.6 ± 4.3. They had hyperglycaemia in 4% (n = 250) and hyperinsulinism in 8 subjects (n = 199). HOMA-IR was elevated in 50.2% and hyperinsulism (Tanner and gender) in 15.9%. Acantose nigricans was present in 18.0% (59). Hypercholesterolemia 15.8% (247) and hypertriglyceridemia 22.7% (242), 28.2% (234) had HDL < 40 mg/dl, mean (sd) of LDL 103.5 mg/dl (29.6), 13.5% with LDL > 130 mg/dl. In 67 of 211 subjects (31.7 %) we found NAFLD, 61.8% were male (p = 0.012). In 222 and 226 registrations of AST and ALT, 7.6% e 20.7% had elevated values; 118 children made abdominal ultrasonography (US) and 28.8% presented signs of hepatic steatosis. In NAFLD children the HOMA-IR values were higher, 2.04 vs 1.96. In children with HOMA-IR elevated 27.5% had NAFLD. The mean (sd) of HDL of non NAFLD was 47.3 (10.9) mg/dl and in NAFLD children was 42.1 (12.8) mg/dl (p = 0.003); the median of triglyceride of non NAFLD population was 73.5 mg/dl and in NAFLD was 90.0 mg/dl (p = 0.042). Conclusions: More than one third of this obese paediatric population presented with NAFLD. It is yet unclear if all overweight children should undergo testing and US to screen NAFLD. We concluded that males with high triglyceride and low HDL had risk profile and must be screened for NAFLD.