Advertisement

Journal of Physiology and Biochemistry

, Volume 65, Issue 1, pp 51–59 | Cite as

Serum transaminases concentrations in obese children and adolescents

  • E. M. González-Gil
  • G. Bueno-Lozano
  • O. Bueno-Lozano
  • L. A. MorenoEmail author
  • L. Cuadrón-Andres
  • P. Huerta-Blas
  • J. M. Garagorri
  • M. Bueno
Article

Abstract

The aim of the study was to investigate the relationship between liver transaminase levels and metabolic syndrome (MS) features in obese children and adolescents. A total of 132 children and adolescents (73 males and 59 females) aged 8–16, participated in the study. All were studied at the department of Paediatrics, University Hospital of Zaragoza (Spain). Inclusion criteria were the existence of obesity as defined by body mass index (BMI) according to Cole cut-off values (when BMI was higher than the age and sex specific equivalent to 30 kg/m2). The definition of metabolic syndrome was according to the International Diabetes Federation criteria. Weight (kg), height (cm), waist circumference (cm), blood pressure and BMI were measured. Laboratory determinations after overnight fasting included: transaminases (ALT, AST, GGT), fasting glucose, insulin, triglycerides and HDL-C. The MS was found in 21.6% of the obese children and adolescents and the prevalence was higher in males (25.9%) than in females (15.9%). Serum transaminases (ALT, AST and GGT) mean concentrations were higher in males than in females, and decreased during pubertal development. The obese children and adolescents with the MS did not show higher transaminases concentrations when compared with those without the MS. Some MS manifestations (mainly waist circumference) showed a correlation with ALT, although all transaminases values were normal according to adult references. Liver transaminases, a surrogate marker of NAFLD, did not show an early and consistent manifestation of abnormalities in the obese children and adolescents studied. In order to define the presence of the disease, it would be necessary to obtain aminotransferase reference standards for children and adolescents, considering pubertal stage and gender.

Key words

Transaminases Children Obesity Metabolic syndrome 

Concentraciones séricas de transaminasas en niños y adolescentes obesos

Resumen

Se valora en el estudio la concentración de transaminasas en niños y adolescentes obesos y se investiga la relación entre enzimas hepáticas y marcadores de síndrome metabólico (SM). Un total de 132 niños y adolescentes (73 chicos y 59 chicas), de 8–16 años, participaron en el estudio. El criterio de inclusión fue la existencia de obesidad definida mediante el índice de masa corporal (IMC) de acuerdo con los valores de Coleet al. (IMC mayor que el equivalente a 30 kg/m2 para una edad y sexo específico). Para definir el síndrome metabólico (MS), se eligieron los criterios de la Federación Internacional de Diabetes. Se realizaron medidas del peso (Kg), altura (cm), perímetro de la cintura y tensión arterial y determinaciones de laboratorio en ayunas de las transaminasas (ALT, AST, GGT), glucosa, insulina, triglicéridos y HDL-C. Presentaron síndrome metabólico el 21,6% de los niños y adolescentes obesos y la prevalencia fue mayor en chicos (25,9%) que en chicas (15,9%). Los componentes más frecuentes del síndrome metabólico fueron la obesidad abdominal (exceso de circunferencia de cintura, 93%) y la tensión arterial elevada (34,3%). Los valores medios de las concentraciones séricas de transaminasas (ALT, AST, GGT) fueron mayores en chicos que en chicas, y disminuyeron según el desarrollo puberal. Los niños y adolescentes obesos con síndrome metabólico no presentaron mayores concentraciones de transaminasas en comparación con los que no tenían síndrome metabólico. Algunas manifestaciones de SM (en particular el perímetro de la cintura) se asociaron con ALT, aunque los valores de transaminasas fueron normales según las referencias usadas para adultos. En los niños estudiados, las transaminasas, un marcador secundario de hígado graso no-alcohólico (NAFLD), no fueron una manifestación temprana y consistente de estas anomalías. Para definir la presencia de la enfermedad, sería necesario obtener valores de referencia de transaminasas para niños y adolescentes, considerando el estadío puberal y el sexo.

Palabras clave

Transaminasas Niños Obesidad Síndrome metabólico 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Brambilla, P., Lissau, I., Flodmark C.E., Moreno, L.A., Widhalm, K., Wabitsch, M.,et al. (2007): Metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome.Int J Obes (Lond),31, 591–600.CrossRefGoogle Scholar
  2. 2.
    Bueno G., Moreno, L.A., Bueno, O., Morales, J., Pérez-Roche, T., Garagorri, J.M. (2007): Metabolic risk-factor clustering estimation in obese children.J Physiol Biochem,63, 347–355.PubMedCrossRefGoogle Scholar
  3. 3.
    Bueno, G., Bueno, O., Moreno, L.A., García, R., Tresaco, B. Garagorri, J.M. (2006): Diversity of metabolic syndrome risk factors in obese children and adolescents.J Physiol Biochem,62, 125–133.PubMedCrossRefGoogle Scholar
  4. 4.
    Burgert, T.S., Taksali, S.E., Dziura, J., Goodman, T.R., Yeckel, C.W., Papademetris, X. (2006): Alanine aminotransferase levels and fatty liver in childhood obesity: associations with insulin resistance, adiponectin, and visceral fat.J Clin Endocrinol Metab,91, 4287–4294.PubMedCrossRefGoogle Scholar
  5. 5.
    Clark, J.M., Brancati, F.L., Diehl, A.M. (2003): The prevalence and etiology of elevated aminotransferase levels in the United States.Am J Gastroenterol,98, 960–967.PubMedCrossRefGoogle Scholar
  6. 6.
    Cole, T.J., Bellizzi, M.C., Flegal, K.M., Dietz, W.H. (2000): Establishing a standard definition for child overweight and obesity worldwide: international survey.Bmj,320, 1240–1243.PubMedCrossRefGoogle Scholar
  7. 7.
    Cook, S., Weitzman, M., Auinger, P., Nguyen, M., Dietz, W.H. (2003): Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988–1994.Arch Pediatr Adolesc Med,157, 821–827PubMedCrossRefGoogle Scholar
  8. 8.
    Fishbein, M.H., Miner, M., Mogren, C., Chalekson, J. (2003): The spectrum of fatty liver in obese children and the relationship of serum aminotransferases to severity of steatosis.J Pediatr Gastroenterol Nutr,36, 54–61.PubMedCrossRefGoogle Scholar
  9. 9.
    Fishbein, M.H., Mogren, C., Gleason, T., Stevens, W.R. (2006): Relationship of hepatic steatosis to adipose tissue distribution in pediatric nonalcoholic fatty liver disease.J Pediatr Gastroenterol Nutr,42, 83–88.PubMedGoogle Scholar
  10. 10.
    Ferranti, S.D., Gauvreau, K., Ludwig, D.S., Neufeld, E.J., Newburger, J.W., Rifai, N. (2004): Prevalence of the metabolic syndrome in American adolescents: findings from the Third National Health and Nutrition Examination Survey.Circulation,110, 2494–2497.PubMedCrossRefGoogle Scholar
  11. 11.
    Haynes, P., Liangpunsakul, S., Chalasani, N. (2004): Nonalcoholic fatty liver disease in individuals with severe obesity.Clin Liver Dis,8, 535–547.PubMedCrossRefGoogle Scholar
  12. 12.
    Hedley, A.A., Ogden, C.L., Johnson, C.L., Carroll, M.D., Curtin, L.R., Flegal, K.M., (2004): Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002.Jama,291, 2847–2850.PubMedCrossRefGoogle Scholar
  13. 13.
    Ioannou, G.N., Weiss, N.S., Boyko, E.J., Kahn, S.E., Lee, S.P., (2005): Contribution of metabolic factors to alanine aminotransferase activity in persons with other causes of liver disease.Gastroenterology,128, 627–635.PubMedCrossRefGoogle Scholar
  14. 14.
    Kotronen, A., Westerbacka, J., Bergholm, R., Pietilainen, K.H., Yki-Jarvinen, H. (2007): Liver fat in the metabolic syndrome.J Clin Endocrinol Metab,92, 3490–3497.PubMedCrossRefGoogle Scholar
  15. 15.
    Kotronen, A., Yki-Jarvinen, H., (2008): Fatty liver, a novel component of the metabolic syndrome.Arterioscler Thromb Vasc Biol,28, 27–38.PubMedCrossRefGoogle Scholar
  16. 16.
    Koska, J., Stefan, N., Permana, P.A., Weyer, C., Sonoda, M., Bogardus, C., (2008): Increased fat accumulation in liver may link insulin resistance with subcutaneous abdominal adipocyte enlargement, visceral adiposity, and hypoadiponectinemia in obese individuals.Am J Clin Nutr,87, 295–302.PubMedGoogle Scholar
  17. 17.
    Lavine, J.E., Schwimmer, J.B., (2004): Nonalcoholic fatty liver disease in the pediatric population.Clin Liver Dis,8, 549–558.PubMedCrossRefGoogle Scholar
  18. 18.
    Lissau, I. (2004): Overweight and obesity epidemic among children. Answer from European countries.Int J Obes Relat Metab Disord,28, S10–5.CrossRefGoogle Scholar
  19. 19.
    Lobstein, T., Frelut, M.L. (2003): Prevalence of overweight among children in Europe.Obes Rev,4, 195–200.PubMedCrossRefGoogle Scholar
  20. 20.
    Tanner, J.M., Whitehouse, R.H., (1976): Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty.Arch Dis Child,51, 170–179.PubMedCrossRefGoogle Scholar
  21. 21.
    Matthews, D.R., Hosker, J.P., Rudenski, A.S., Naylor, B.A., Treacher, D.F., Turner, R.C. (1985): Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.Diabetologia,28, 412–419.PubMedCrossRefGoogle Scholar
  22. 22.
    Moreno, L.A., Fleta, J., Mur, L., Rodriquez, G., Sarria, A., Bueno, M. (1999): Waist circumference values in Spanish children—gender related differences.Eur J Clin Nutr,53, 429–433.PubMedCrossRefGoogle Scholar
  23. 23.
    Moreno, L.A., Mesana, M.I., Fleta, J., Ruiz, J.R., Gonzalez-Gross, M., Sarria, A., (2005): Overweight, obesity and body fat composition in spanish adolescents. The AVENA Study.Ann Nutr Metab,49, 71–76.PubMedCrossRefGoogle Scholar
  24. 24.
    Moreno, L.A., Pineda, I., Rodriguez, G., Fleta, J., Sarria, A., Bueno, M., (2002): Waist circumference for the screening, of the metabolic syndrome in children.Acta Paediatr,91, 1307–1312.PubMedCrossRefGoogle Scholar
  25. 25.
    Neuschwander-Tetri, B.A., Caldwell, S.H. (2003): Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference.Hepatology,37, 1202–1219.PubMedCrossRefGoogle Scholar
  26. 26.
    Patton, H.M., Sirlin, C., Behling, C., Middleton, M., Schwimmer, J.B., Lavine, J.E., (2006) Pediatric nonalcoholic fatty liver disease: a critical appraisal of current data and implications for future research.J Pediatr Gastroenterol Nutr,43, 413–427.PubMedCrossRefGoogle Scholar
  27. 27.
    Prati, D., Taioli, E., Zanella, A., Della Torre, E., Butelli, S., Del Vecchio, E., (2002) Updated definitions of healthy ranges for serum alanine aminotransferase levels.Ann Intern Med,137, 1–10.PubMedGoogle Scholar
  28. 28.
    Radetti, G., Kleon, W., Stuefer, J., Pittschieler, K. (2006): Non-alcoholic fatty liver disease in obese children evaluated by magnetic resonance imaging.Acta Paediatr,95, 833–837.PubMedCrossRefGoogle Scholar
  29. 29.
    Sattar, N., Scherbakova, O., Ford, I., O’Reilly, D.S., Stanley, A., Forrest, E., (2004): Elevated alanine aminotransferase predicts new-onset type 2 diabetes independently of classical risk factors, metabolic syndrome, and C-reactive protein in the west of Scotland coronary prevention study.Diabetes,53, 2855–2860.PubMedCrossRefGoogle Scholar
  30. 30.
    Schwimmer, J.B., Deutsch, R., Kahen, T., Lavine, J.E., Stanley, C., Behling, C. (2006) Prevalence of fatty liver in children and adolescents.Pediatrics,118, 1388–1393.PubMedCrossRefGoogle Scholar
  31. 31.
    Schwimmer, J.B., Pardee, P.E., Lavine, J.E., Blumkin, A.K., Cook, S. (2008): Cardiovascular risk factors and the metabolic syndrome in pediatric nonalcoholic fatty liver disease.Circulation,118, 277–283.PubMedCrossRefGoogle Scholar
  32. 32.
    Tazawa, Y., Noguchi, H., Nishinomiya, F., Takada, G. (1997): Serum alanine aminotransferase activity in obese children.Acta Paediatr,86, 238–241.PubMedCrossRefGoogle Scholar
  33. 33.
    Wallace, T.M., Utzschneider, K.M., Tong, J., Carr, D.B., Zraika, S., Bankson, D.D. (2007): Relationship of liver enzymes to insulin sensitivity and intra-abdominal fat.Diabetes Care,30, 2673–2678.PubMedCrossRefGoogle Scholar
  34. 34.
    Wan, N.J., Mi, J., Wang, T.Y., Duan, J.L., Li, M., Gong, C.X. (2007): Metabolic syndrome in over-weight and obese schoolchildren in Beijing.Zhonghua Er Ke Za Zhi,45, 417–421.PubMedGoogle Scholar
  35. 35.
    Weiss, R., Dziura, J., Burgert, T.S., Tamborlane, W.V., Taksali, S.E., Yeckel, C.W. (2004): Obesity and the metabolic syndrome in children and adolescents.N Engl J Med,350, 2362–2374.PubMedCrossRefGoogle Scholar
  36. 36.
    Wieckowska, A., Feldstein, A.E. (2008): Diagnosis of nonalcoholic fatty liver disease: invasive versus noninvasive.Semin Liver Dis,28, 386–395.PubMedCrossRefGoogle Scholar
  37. 37.
    Zimmet, P., Alberti, G., Kaufman, F., Tajima, N., Silink, M., Arslanian, S. (2007): The metabolic syndrome in children and adolescents.Lancet,369, 2059–2061.PubMedCrossRefGoogle Scholar

Copyright information

© Universidad de Navarra 2009

Authors and Affiliations

  • E. M. González-Gil
    • 1
  • G. Bueno-Lozano
    • 2
  • O. Bueno-Lozano
    • 2
  • L. A. Moreno
    • 1
    • 3
    Email author
  • L. Cuadrón-Andres
    • 2
  • P. Huerta-Blas
    • 2
  • J. M. Garagorri
    • 2
  • M. Bueno
    • 2
  1. 1.Growth, Exercise, Nutrition and Development (GENUD) research groupUniversity of ZaragozSpain
  2. 2.Paediatric DepartmentUniversity Clinical Hospital “Lozano Blesa”Spain
  3. 3.School of Health SciencesUniversity of ZaragozaSpain

Personalised recommendations