Abstract
ObjectivesThis study aimed to determine the prevalence of the metabolic syndrome, abnormalities of liver enzymes and sonographic fatty liver, as well as the inter-related associations in normal weight, overweight and obese children and adolescents.MethodsThis cross-sectional study was conducted among a sample of 1107 students (56.1% girls), aged 6-18 years in Isfahan, Iran. In addition to physical examination, fasting blood glucose, serum lipid profile and liver enzymes were determined. Liver sonography was performed among 931 participants. These variables were compared among participants with different body mass index (BMI) categories.ResultsFrom lower to higher BMI category, alanine aminotransferase (ALT), total cholesterol, LDL-cholesterol, triglycerides and systolic blood pressure increased, and HDL-cholesterol decreased significantly. Elevated ALT, aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were documented in respectively 4.1%, 6.6% and 9.8% of normal weight group. The corresponding figure was 9.5%, 9.8% and 9.1% in overweight group, and 16.9%, 14.9% and 10.8% in obese group, respectively. In all BMI categories, ALT increased significantly by increasing the number of the components of the metabolic syndrome. Odds ratio for elevated liver enzymes and sonographic fatty liver increased significantly with higher number of the components of the metabolic syndrome and higher BMI categories before and after adjustment for age.ConclusionsBecause of the interrelationship of biochemical and sonographic indexes of fatty liver with the components of the metabolic syndrome, and with increase in their number, it is suggested to determine the clinical impact of such association in future longitudinal studies.
Highlights
Overweight and obesity in children have become a worldwide problem, no more limited to high-income countries; among developing countries, the Middle East has one the highest rates of childhood obesity [1]
Definition of elevated liver enzymes, metabolic syndrome and sonographic fatty liver According to the study design, we had included nearly similar proportions of normal-weight, overweight and obese participants, the percentiles of liver function tests were determined in a sub-sample of participants with a body mass index (BMI) distribution similar to the proportions documented in the whole 7554 students studied with a prevalence of 9.34% of overweight and 5.33% of obesity as we described before [15]
Cardio-metabolic risk factors with liver enzymes are presented in Table 2, and shows significant correlations in different BMI categories
Summary
Overweight and obesity in children have become a worldwide problem, no more limited to high-income countries; among developing countries, the Middle East has one the highest rates of childhood obesity [1]. Metabolic syndrome, which is a constellation of metabolic abnormalities including insulin resistance, hyperinsulinemia, glucose intolerance, dyslipidemia, and hypertension, is common in overweight youths, affecting around 30% of overweight children and adolescents in the United States [4]. It probably plays an important role in developing type 2 diabetes and atherosclerotic cardiovascular diseases [5]. NAFLD includes different ranges of liver pathologies and outcomes from simple steatosis to nonalcoholic steatohepatitis (NASH) [6] The latter could be more severe in children from special ethnic groups, such as Hispanics and Asians [8]. To the best of our knowledge, this is the first study of its kind in
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