Abstract:

Purpose: Non-alcoholic fatty liver disease (NAFLD) and associated morbidities have become a public health problem due to a global three-fold increase in incidence among obese children over the last three decades. Although the gold standard for diagnosis of NAFLD is liver biopsy, it is not widely used in children. Imaging techniques, including magnetic resonance and ultrasound, can provide information on liver fat deposition, with variable sensitivity. Therefore, a number of other predictors are being investigated for pediatric screening and diagnostic purposes. The aim of this study was to assess easily measured parameters to prompt further investigation for NAFLD in obese children. Methods: Obese children/adolescents with a Body Mass Index (BMI) percentile >95 were enrolled in the study (n=353). After a 12-hour fast, venous glucose, insulin, cholesterol, triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and uric acid were measured and full blood count was performed in all subjects. The TG/LDL ratio, the AST/platelet ratio index (APRI score) and the Homeostatic Model of Assessment-Insulin Resistance (HOMA-IR) were calculated. All patients underwent abdominal ultrasound examination to assess heaptosteatosis. Results: Of 353 patients, median age 12.5 (range: 6-17.9) years, 210 (59%) patients had US-proven hepatosteatosis. Female gender reduced the risk of steatosis 2.08 fold (p=0.005), one unit increase in HDL reduced the risk of steatosis 1.02 fold (p=0.042) and one unit increase in the BMI led to a 1.11 fold (p=0.002) increase in the risk of steatosis. Conclusion: Gender, BMI and HDL were found to be predictors of steatosis. Male patients with low HDL and high BMI are at greater risk of steatosis and should be carefully examined for the presence of NAFLD.

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