Abstract
Background
The aim of this study is to identify obese children who are candidates for a potential diagnosis of non-alcoholic fatty liver disease (NAFLD).
Methods
We enrolled 242 obese children (122 boys and 120 girls) aged 7-16 years who were examined with abdominal ultrasonography in our pediatric obesity clinic. We compared patients in the normal group with those in the NAFLD group (mild disease, moderate to severe disease) and identified the optimal anthropometric parameters among height, weight, body mass index (BMI), waist circumference, hip circumference, waist to height ratio (WHtR), and waist to hip ratio to predict NAFLD using a receiver operating characteristic curve analysis. We also investigated risk factors associated with NAFLD for the anthropometric parameters and the biochemical model using logistic regression.
Results
The high- and low-risk groups for hepatic steatosis relative to a WHtR of 0.56 as the standard point showed significant differences in hepatic steatosis severity grade (P<0.001), BMI (P=0.004), hip circumference (P=0.090), aspartate aminotransferase (P<0.001), alanine aminotransferase (P<0.001), triglycerides (P=0.001), and the triglyceride to high-density lipoprotein (HDL) cholesterol ratio (P=0.006). Risk factors for hepatic steatosis on logistic regression analysis were male sex (odds ratio: 3.68, 95% confidence interval: 1.76-7.70), WHtR >0.56 (2.25, 1.05-4.81), and waist circumference >90th percentile (20.22, 9.21-44.36) in the anthropometric parameter model and elevated alanine aminotransferase levels (boys >25.8 U/L, girls >22.1 U/L) (6.93, 2.52-19.03), hypertriglyceridemia (>110 mg/dL) (3.80, 1.23-11.75), and triglyceride to HDL cholesterol ratio >3 (9.23, 2.95-8.83) in the biochemical parameter model.
Conclusion
A diagnostic approach to hepatic steatosis is recommended as part of the proper screening and stratification of risk factors in obese children. WHtR is a simple and convenient method of effectively identifying obese children who are candidates for hepatic steatosis screening.
Similar content being viewed by others
References
Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology 2006;43:S99–S112.
Nobili V, Svegliati-Baroni G, Alisi A, Miele L, Valenti L, Vajro P. A 360-degree overview of paediatric NAFLD: recent insights. J Hepatol 2013;58:1218–1229.
Alisi A, Manco M, Vania A, Nobili V. Pediatric nonalcoholic fatty liver disease in 2009. J Pediatr 2009;155:469–474.
Della Corte C, Vajro P, Socha P, Nobili V. Pediatric nonalcoholic fatty liver disease: recent advances. Clin Res Hepatol Gastroenterol 2014;38:419–422.
Alisi A, Feldstein AE, Villani A, Raponi M, Nobili V. Pediatric nonalcoholic fatty liver disease: a multidisciplinary approach. Nat Rev Gastroenterol Hepatol 2012;9:152–161.
Welsh JA, Karpen S, Vos MB. Increasing prevalence of nonalcoholic fatty liver disease among United States adolescents, 1988-1994 to 2007-2010. J Pediatr 2013;162:496–500.
Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of fatty liver in children and adolescents. Pediatrics 2006;118:1388–1393.
Boyraz M, Hatipoglu N, Sari E, Akcay A, Taskin N, Ulucan K, et al. Non-alcoholic fatty liver disease in obese children and the relationship between metabolic syndrome criteria. Obes Res Clin Pract 2014;8:e356–e363.
Yki-Järvinen H. Liver fat in the pathogenesis of insulin resistance and type 2 diabetes. Dig Dis 2010;28:203–209.
Atabek ME, Selver Eklioglu B, Akyurek N. Which metabolic syndrome criteria best predict non-alcoholic fatty liver disease in children? Eating Weight Disord 2014;103:e349–e353.
Fu JF, Shi HB, Liu LR, Jiang P, Liang L, Wang CL, et al. Nonalcoholic fatty liver disease: An early mediator predicting metabolic syndrome in obese children? World J Gastroenterol 2011;17:735–742.
Vajro P, Lenta S, Socha P, Dhawan A, Mckieman P, Baumann U, et al. Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr 2012;54:700–713.
Shannon A, Alkhouri N, Carter-Kent C, Monti L, Devito R, Lopez R, et al. Ultrasonographic quantitative estimation of hepatic steatosis in children With NAFLD. J Pediatr Gastroenterol Nutr 2011;53:190–195.
Perito ER, Tsai PM, Hawley S, Lustig RH, Feldstein VA. Targeted hepatic sonography during clinic visits for detection of fatty liver in overweight children: a pilot study. J Ultrasound Med 2013;32:637–643.
Schwimmer JB, Dunn W, Norman GJ, Pardee PE, Middleton MS, Kerkar N, et al. SAFETY study: alanine aminotransferase cutoffvalues are set too high for reliable detection of pediatric chronic liver disease. Gastroenterology 2010;138:1357–1364, 1364. e1-2.
Tsuruta G, Tanaka N, Hongo M, Komatsu M, Horiuchi A, Hamamoto K, et al. Nonalcoholic fatty liver disease in Japanese junior high school students: its prevalence and relationship to lifestyle habits. J Gastroenterol 2010;45:666–672.
Osawa H, Mori Y. Sonographic diagnosis of fatty liver using a histogram technique that compares liver and renal cortical echo amplitudes. J Clin Ultrasound 1996;24:25–29.
Alp H, Karaarslan S, Selver Eklioglu B, Atabek ME, Altin H, Baysal T. Association between nonalcoholic fatty liver disease and cardiovascular risk in obese children and adolescents. Can J Cardiol 2013;29:1118–1125.
Manco M, Bedogni G, Marcellini M, Devito R, Ciampalini P, Sartorelli M, et al. Waist circumference correlates with liver fibrosis in children with non-alcoholic steatohepatitis. Gut 2008;57:1283–1287.
Brambilla P, Bedogni G, Moreno LA, Goran MI, Gutin B, Fox KR, et al. Crossvalidation of anthropometry against magnetic resonance imaging for the assessment of visceral and subcutaneous adipose tissue in children. Int J Obes (Lond) 2006;30:23–30.
Mager DR, Yap J, Rodriguez-Dimitrescu C, Mazurak V, Ball G, Gilmour S. Anthropometric measures of visceral and subcutaneous fat are important in the determination of metabolic dysregulation in boys and girls at risk for nonalcoholic fatty liver disease. Nutr Clin Pract 2013;28:101–111.
Tilg H, Moschen AR. Insulin resistance, inflammation, and non-alcoholic fatty liver disease. Trends Endocrinol Metab 2008;19:371–379.
Nobili V, Alisi A, Vania A, Tiribelli C, Pietrobattista A, Bedogni G. The pediatric NAFLD fibrosis index: a predictor of liver fibrosis in children with non-alcoholic fatty liver disease. BMC Med 2009;7:21.
Nambiar S, Truby H, Hughes I, Davies PS. Utility of the waistto-height ratio as an instrument to measure parental perception of body weight in children and its use in a population-based survey of children. Pub Health Nutr 2013;16:274–280.
Yoo HJ, Park MS, Lee CH, Yang SJ, Kim TN, Lim KI, et al. Cutoffpoints of abdominal obesity indices in screening for nonalcoholic fatty liver disease in Asians. Liver Int 2010;30:1189–1196.
Devadason CA, Scheimann AO. Overview of screening methods for fatty liver disease in children. World J Hepatol 2012;4:1–4.
Strauss RS, Barlow SE, Dietz WH. Prevalence of abnormal serum aminotransferase values in overweight and obese adolescents. J Pediatr 2000;136:727–733.
Oliveira AM, Oliveira N, Reis JC, Santos MV, Silva AM, Adan L. Triglycerides and alanine aminotransferase as screening markers for suspected fatty liver disease in obese children and adolescents. Horm Res 2009;71:83–88.
Schwimmer JB, Deutsch R, Rauch JB, Behling C, Newbury R, Lavine JE. Obesity, insulin resistance, and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease. J Pediatr 2003;143:500–505.
Quirós-Tejeira RE, Rivera CA, Ziba TT, Mehta N, Smith CW, Butte NF. Risk for nonalcoholic fatty liver disease in Hispanic youth with BMI 95th percentile. J Pediatr Gastroenterol Nutr 2007;44:228–236.
Hannon TS, Bacha F, Lee SJ, Janosky J, Arslanian SA. Use of markers of dyslipidemia to identify overweight youth with insulin resistance. Pediatr Diabetes 2006;7:260–266.
Bailey DP, Savory LA, Denton SJ, Davies BR, Kerr CJ. The triglyceride to high-density lipoprotein ratio identifies children who may be at risk of developing cardiometabolic disease. Acta Paediatr 2014;103:e349–e353.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lee, J.H., Jeong, S.J. What is the appropriate strategy for diagnosing NAFLD using ultrasonography in obese children?. World J Pediatr 13, 248–254 (2017). https://doi.org/10.1007/s12519-017-0008-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12519-017-0008-7