Hepatic Steatosis and Related Factors in Obese Children Attending National Nutritional Institute
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- Category: Vol. 84, June 2016
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Hepatic Steatosis and Related Factors in Obese Children Attending National Nutritional Institute, AZZA O.L. SALEH, ZEINAB A. ABD EL-AAL, OLA A.W. HAMED, SAHAR A.M. EL-RAFIE and GIHAN FOUAD
Abstract
Background: According to a report from the World Health Organization in 2011, the prevalence of obesity has doubled in the last 30 years, and the population of overweight children and adolescents under 18 years of age is 17 million with an annual increase of 0.5-1 percent. Childhood obesity can cause many complications such as hyperlipidemia and steatohepatitis at an early age. It may also lead to obesity in adulthood and thereby result in many lifestyle diseases and affect quality of life. Several studies reported that some of obese children have above normal levels of serum triglycerides and total cholesterol. Fatty liver, as a result of obesity, can progress to liver cirrhosis and according to some researches obese children were found to have non-alcoholic fatty liver diseases.
Objectives: To assess the correlation between severity of ultrasonographic hepatic steatosis and degree of obesity, and serum biochemical indicators.
Methods: The study included 141 obese children attending the outpatient child obesity clinic in the National Nutrition Institute (NNI). Both sexes were included with age range from 6-13 years. Body weight, body height, waist and hip perimeters were measured and Body Mass Index (BMI) was calculated. Obesity was defined accordingly, adjusted by sex and age to be >!95th percentile. Hepatic steatosis was defined by abdominal ultrasound which was performed for all enrolled individuals. The grades of fatty liver (hepatosteatosis) described by US are qualitatively defined using a four-point scale as follows: Normal, mild, moderate or severe. All children were subjected to blood biochemistry tests including blood glucose, AST, ALT and Gamma GT besides estimation of lipid profile.
Results: Hepatic steatosis was detected in 85.1% of the obese children enrolled in the study. The steatosis group presented higher values than the normal group with high significant difference for waist perimeter (p=0.000), hip perimeter (p=0.000) and age (0.020), as well as higher levels of height, weight and BMI (p=0.056). The steatosis group also presented higher blood levels of triglycerides (p=0.012), and cholesterol (p=0.017). On the other hand, GGT (p=0.055) was significantly lower among this group compared to the group with no steatosis. Of the 141 children who were examined by abdominal US, 14.9% were normal, 25.5% were having mild steatosis, 42.6% displayed moderate steatosis and 17.02% showed severe steatosis. Children with no steatosis showed similar results as the children having mild steatosis as regards age, height and waist/hip ratio. On the other hand, the comparison between all the groups showed a high signif-icant increase as regards the weight (p=0.022), BMI (p=0.016), Waist perimeter (p=0.000) and hip perimeter (p=0.000). The increase in the values of these parameters was directly pro-portional to the grade of hepatic steatosis. Hepatic steatosis showed statistically significant correlation with height, weight, BMI, waist and hip perimeters while there was no significant correlation with waist/hip ratio.
Comparison between all the groups showed a high signif-icant increase as regards ALT (p=0.008), AST (p=0.009) and Triglyceride (p=0.057). The increase in the values of these parameters was directly proportional to the grades of hepatic steatosis. GGT and HDL-cholesterol showed decrease among the 4 groups. The decrease is indirectly proportional to the grades of hepatic steatosis.
Conclusion: Hepatic steatosis is a substantial problem in children and has a close relationship with obesity and dyslip-idemia. Body mass index, liver transaminases and serum lipid profile can be used as tools for the diagnosis of hepatic steatosis.