Prevalence of fatty liver disease in children with obesity- a diagnostic study based on its ultrasound appearance
Keywords:BMI, Diagnosis, Fatty liver grading, NAFLD/NASH, Obesity, Ultrasound
Background: Non-alcoholic fatty liver disease is an asymptomatic involvement of the liver, can progress to chronic liver disease and must be identified at an early stage for good prognosis. The implementation of the appropriate therapeutic interventions is determinant of the attempts to treat it. For that purpose, early diagnosis and staging of the disease is essential. It seems that diagnostic imaging should be a first-line tool for the staging and monitoring pediatric NAFLD/NASH for appropriate interventions to be implanted in a timely way. This study evaluated the prevalence of fatty liver in relation with body mass index (BMI) by means of ultrasound in children of age group 6-15 years.
Methods: In this cross-sectional study, 83 children aged 6 to 15 years, were selected randomly. The participants were examined by a pediatrician. Liver ultrasound was performed for all children and grade of fatty liver was determined.
Results: There was a significant correlation between grade of fatty liver with BMI, our study showed a strong association between BMI and prevalence of fatty liver on ultrasound.
Conclusions: According to the study hypothesis, based on BMI, the degree of NAFLD in children were predictable. Ultrasound of liver in grading of fatty liver is one of the assessments methods of fatty liver but it is not a diagnostic method; it is useful for prevention to reduce BMI.
Alexander J, Torbenson M, Wu TT, Yeh MM. Non-alcoholic fatty liver disease contributes to hepato carcinogenesis in non-cirrhotic liver: a clinical and pathological study. J Gastroenterol Hepatol. 2013;28:848-54.
Unnithan G, Kumari S. Prevalence of overweight and obesity and underweight in school going children of rural and urban areas of Trivandrum educational district, Kerala State. Internet J Nutr Wellness. 2008;6(2).
Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati FL, Guallar E, et al. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology. 2011;54:1082-90.
Ballestri S, Lonardo A, Romagnoli D, Carulli L, Losi L, Day CP, et al. Ultrasonographic fatty liver indicator, a novel score which rules out NASH and is correlated with metabolic parameters in NAFLD. Liver Int. 2012;32:1242-52.
Hamaguchi M, Kojima T, Itoh Y, Harano Y, Fujii K, Nakajima T, et al. The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulatio. Am J Gastroenterol. 2007;102:2708-15.
Shannon A, Alkhouri N, Carter-Kent C, Monti L, Devito R, Lopez R, et al. Ultrasonographic quantitative estimation of hepatic steatosis in children With NAFLD. J Pediatr Gastroenterol Nutr. 2011;53:190-5.
Moran JR, Ghishan FK, Halter SA, et al. Steatohepatitis in obese children: a cause of chronic liver dysfunction. Am J Gastroenterol. 1983;78:374–377.
Draijer LG, Feddouli S, Bohte AE, vd Baan Slootweg O, Pels Rijcken TH, Benninga MA, et al. Comparison of diagnostic accuracy of screening tests ALT and ultrasound for pediatric non-alcoholic fatty liver diseas. Eur J Pediatr. 2019;178:863-70.
Karabouta Z, Papandreou D, Makedou A, Rousso I, Athanassiadou F. Associations of apolipoprotein A, high-sensitivity C-reactive protein and fasting plasma insulin in obese children with and without family history of cardiovascular disease. J Clin Med Res. 2016;8:431-6.
Papandreou D, Karabouta Z, Rousso PA. Investigation of anthropometric, biochemical and dietary parameters of obese children with and without non-alcoholic fatty liver disease. Appetite. 2012;59:939-44.
Wei Y, Rector RS, Thyfault JP, Ibdah JA. Nonalcoholic fatty liver disease and mitochondrial dysfunctio. World J Gastroenterol. 2008;14:193-9.
Cherian AT, Cherian SS, Subbiah S. Prevalence of obesity and overweight in urban school children in Kerala, India. Indian Pediatr. 2012;49:475-7.
Ahmed MH, Noor SK, Bushara SO, Husain NE, Elmadhoun WM, Ginawi IA, et al. Non-alcoholic fatty liver disease in africa and middle east: an attempt to predict the present and future implications on the healthcare system. Gastroenterol Res. 2017;10:271-9.
Bril F, Ortiz-Lopez C, Lomonaco R, Orsak B, Freckleton M, Chintapalli K, et al. Clinical value of liver ultrasound for the diagnosis of nonalcoholic fatty liver disease in overweight and obese patients. Liver Int. 2015;35:2139-46.
Younesian A. Prevalence of fatty liver using ultrasound in male high-school pupils without history of liver disease and its relationship with liver enzymes, body mass index and waist - hip ratio. Razi Journal of Medical Sciences 2015;132(22);80-86.
Kruger AJ, Fuchs BC, Masia R, Holmes JA, Salloum S, Sojoodi M, Ferreira DS, Rutledge SM, Caravan P, Alatrakchi N, et al. Prolonged cenicriviroc therapy reduces hepatic fibrosis despite steatohepatitis in a diet-induced mouse model of nonalcoholic steatohepatitis. Hepatol Commun. 2018;2:529–545.
Anahita Zakeri, Sepideh Karamat-PanahPrevalence of non-alcoholic fatty liver disease and its risk factors in patients.
Hossein Bahrami, Nasser Ebrahimi Daryani, Shahram Mirmomen, Farin Kamangar, Babak Haghpanah and Mehdi Djalili Address: Digestive Diseases Research Center – Imam Hospital, Tehran University of Medical Sciences.