P0040 PP FATTY ACID METABOLISM IN OBESE CHILDREN WITH OR WITHOUT STEATOHEPATITIS

Abstract

Introduction: Obesity is a common problem in children. The prevalence of childhood obesity is about 10–15% in Taiwan and 20–25% in USA. NASH has been estimated to be 5% in general population and 25–75% in obese adults in USA. NASH may progress to cirrhosis and liver-related death in 25% and 10% of patients, respectively. It is long being known that some obese children had evaluated serum aminotransferases but most obese children did not. NASH had been reported in some of these obese children with elevated serum aminotransferases. Dyslipidemia with abnormal fatty acid metabolism in the liver might be the mechanism of forming steatohepatitis in obese children. The goal of the study was testing the hypothesis that the fatty acid metabolism in the liver is abnormal in children who are obese with/without steatohepatitis. Methods: 1). Patients: Children who are obese (body weight is more than 120% of weight-for-height-for-age) with/without elevated aminotransferases were enrolled in the study. 2). The blood samples will be collected on the Guthrie cards after NPO for eight hours and stored in the refrigerator until analyzed. 3). The fatty acids of the blood samples will be analyzed by Finnigan Triple Quadrupole TSQ 7000 LC/MS/MS. Results: 1). 28 obese children and 28 non-obese children were included. 2). Six of the 28 obese children had ALT elevation. 3). The difference of acylcarnitine levels of the obese or non-obese children was not singnificant. Conclusion: The pathophysiology of NASH involves two steps. The first is insulin resistance, which causes steatosis. The second is oxidative stress, which produces lipid peroxidation and activates inflammatory cytokines resulting in NASH. Eight of our patients had ALT >44, but only 2 of them had Insulin level >24.4. Insuline resistance seems not obvious in this patient group. It has been reported that in overweight/obese adult patients NASH is associated with deranged fatty acid metabolism. The fatty acid metabolism of the liver is not different between obese or non-obese children, even in the group of obese children with elevated aminotransferases. The possible cause of fatty liver and/or NASH in the obese children remains unclear.