Abstract
Background: Childhood non-alcoholic fatty liver disease (NAFLD) is a public health issue worldwide. To date, liver biopsy remains the gold standard for diagnosing the severity of NAFLD. However, this invasive procedure might contribute to complications. Owing to this reason, a good non-invasive tool to estimate NAFLD in children is urgently needed. We sought to investigate whether a non-invasive semi-quantitative ultrasonographic fatty liver indicator (US-FLI) can estimate NAFLD in children.Methods: Children aged between 10 and 18 years were enrolled prospectively. Abdominal ultrasonography was performed by a single experienced pediatric gastroenterologist and the non-invasive semi-quantitative US-FLI score were used. Patients were diagnosed with NAFLD if they had a US-FLI score ≥2. The anthropometric measures, obesity-related biochemical results, and levels of tumor necrosis factor-α, interleukin-6, caspase-cleaved cytokeratin fragment of cytokeratin 18 (M30), and adiponectin were also checked.Results: Overall, 117 children aged 10–18 years were enrolled. The anthropometric measures and obesity-related biochemical parameters (hsCRP, triglyceride, uric acid, AST, ALT, γ-GT, homeostatic model assessment insulin resistance (HOMA-IR), and M30) were significantly higher in the obesity group than in the non-obesity group (p < 0.05). Similarly, the US-FLI score was significantly higher in the obesity group than that in the non-obesity group (p < 0.001). Multiple linear regression showed that the US-FLI score was significantly associated with the waist-to-height ratio, uric acid, adiponectin, and M30 levels (all p < 0.05) in children with obesity. The US-FLI score ≥6 was the optimal cut-off point for predicting the hepatitis in children with NAFLD. The area under the receiver operating characteristic curve was 0.710 (95% CI: 0.572–0.847; p = 0.005).Conclusions: The non-invasive US-FLI score can predict hepatitis in children with NAFLD without mandatory liver biopsy. Moreover, the waist-to-height ratio, uric acid, adiponectin, and M30 levels were significantly associated with US-FLI score in children with obesity.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is a spectrum of disease comprising simple steatosis, fibrosis, and liver cirrhosis, as well as results in chronic liver disease in the future
We identified the maximum value of Youden’s index and the optimal threshold value was used as the cut-off point to determine the sensitivity, specificity, positive predictive values of ultrasonographic fatty liver indicator (US-FLI) score for detecting the presence of hepatitis in children with NAFLD
The Waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), blood pressure, and levels of hsCRP, triglyceride, uric acid, aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-GT, HOMA-insulin resistance (IR), and M30 were significantly higher in the obesity group than in the non-obesity group (p < 0.001 for all)
Summary
Non-alcoholic fatty liver disease (NAFLD) is a spectrum of disease comprising simple steatosis, fibrosis, and liver cirrhosis, as well as results in chronic liver disease in the future. Liver biopsy remains the gold-standard to determine the severity of NAFLD [4]. With the gradual increase in the incidence of this disease, it has been a challenge for pediatricians to develop a non-invasive tool to estimate NAFLD earlier in children. Childhood non-alcoholic fatty liver disease (NAFLD) is a public health issue worldwide. Liver biopsy remains the gold standard for diagnosing the severity of NAFLD. This invasive procedure might contribute to complications. Owing to this reason, a good non-invasive tool to estimate NAFLD in children is urgently needed. We sought to investigate whether a non-invasive semi-quantitative ultrasonographic fatty liver indicator (US-FLI) can estimate NAFLD in children
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