Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in Albanian overweight children

K Kodhelaj, B Resuli, E Petrela, V Malaj, H Jaze
Minerva Pediatrica 2014, 66 (1): 23-30

AIM: Overweight and obesity has emerged as a significant global health problem in the pediatric population. Childhood non-alcoholic fatty liver disease (NAFLD) has become a common and important liver disease. Although mostly benign, some children with NAFLD develop fibrosis and in some case cirrhosis. The aims of this study were to determine the prevalence of NAFLD/non-alcoholic steatohepatitis (NASH) in overweight Albanian children, to evaluate the demographic and biochemical details and to assess the association between the severity of fatty liver changes and demographic and biochemical abnormalities.

METHODS: A total of 80 school aged children, 24 overweight (85th≤BMI≤94th percentile) and 55 obese (BMI≥94th percentile), aged 10.43±2.2 years (M±SD) were included in the current study, in January-December 2010. Their age was in the range of 7-15 years. Their sex distribution was 36 female and 44 male. The children were enrolled to the Tirana schools and none of them were part of any weight or diet programmer. Children who were found to have TBC, evidence of HBV or HCV, infections, drug toxicity, autoimmune hepatitis, inborn error of metabolism or concomitant cortisteroid therapy were excluded. Laboratory parameters were measured at the time of bioclinical examinations. Fatty liver was diagnosed by ultrasonography detection of the most characteristic features of fatty infiltration. The scoring system was used in order to graduate the severity of the disease. The child was considered to have mild, moderate and severe fatty liver changes if the overall score was 1-3, 4-6 and 7-9, respectively. Multivariate regression analysis was used to assess the association between the different variables and the severity of NAFLD.

RESULTS: NAFLD was present in 55/80 (68.7%) of the overweight children, 34 (61.8%) boys and 21 (38.2%) girls. Mild, moderate and severe degree of fatty liver were found in 35 (43.7%), 19 (23.7%) and 1 (1.3%), respectively. Nash was seen in 13 (23.7%) of the children's with NAFLD. Univariate analysis revealed that weight, BMI, waist, fasting blood insulinemia, triglycerides, total cholesterol and HOMA-IR were significantly associated with the presence of NAFLD (P<0.001). Multivariate analysis revealed a consistent and strong positive association between severity of fatty liver and weight, BMI, waist, fasting blood Insulinemia, cholesterolemia, triglyceridemia and HOMA-IR (P<0.001).

CONCLUSION: NAFLD/NASH was frequent among our cohort of overweight children (68.7% and 23.7%). Weight, waist, BM, hypercholesterolemia, hypertriglyceridemia, fasting serum Insulinemia and HOMA-IR are independent predictors of liver steatosis in overweight children. Hyperinsulinemia and insulin resistance, especially when are associated with elevate values of ALT level, are strong independent risk factors in developing NAFLD/NASH.

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