A Nomogram for Predicting Non-Alcoholic Fatty Liver Disease in Obese Children
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Non-alcoholic fatty liver disease (NAFLD) ranges in severity from simple steatosis to steatohepatitis. Early detection of NAFLD is important for preventing the disease from progressing to become an irreversible end-stage liver disease. We developed a nomogram that allows for non-invasive screening for NAFLD in obese children. Methods: Anthropometric and laboratory data of 180 patients from our pediatric obesity clinic were collected. Diagnoses of NAFLD were based on abdominal ultrasonographic findings. The nomogram was constructed using predictors from a multivariate analysis of NAFLD risk factors. Results: The subjects were divided into non-NAFLD (n=67) and NAFLD groups (n=113). Factors, including sex, body mass index, abdominal circumference, blood pressure, insulin resistance, and levels of aspartate aminotransferase, alanine aminotransferase (ALT), γ-glutamyl transpeptidase (γGT), uric acid, triglycerides, and insulin, were significantly different between the two groups (all p<0.05) as determined using homeostatis model assessment of insulin resistance (HOMA-IR). In our multivariate logistic regression analysis, elevated serum ALT, γGT, and triglyceride levels were significantly related to NAFLD development. The nomogram was established using γGT, uric acid, triglycerides, HOMA-IR, and ALT as predictors of NAFLD probability. Conclusion: The newly developed nomogram may help predict NAFLD risk in obese children. The nomogram may also allow for early NAFLD diagnosis without the need for invasive liver biopsy or expensive liver imaging, and may also allow clinicians to intervene early to prevent the progression of NAFLD to become a more advanced liver disease.
Abstract
Purpose: Non-alcoholic fatty liver disease (NAFLD) ranges in severity from simple steatosis to steatohepatitis. Early detection of NAFLD is important for preventing the disease from progressing to become an irreversible end-stage liver disease. We developed a nomogram that allows for non-invasive screening for NAFLD in obese children. Methods: Anthropometric and laboratory data of 180 patients from our pediatric obesity clinic were collected. Diagnoses of NAFLD were based on abdominal ultrasonographic findings. The nomogram was constructed using predictors from a multivariate analysis of NAFLD risk factors. Results: The subjects were divided into non-NAFLD (n=67) and NAFLD groups (n=113). Factors, including sex, body mass index, abdominal circumference, blood pressure, insulin resistance, and levels of aspartate aminotransferase, alanine aminotransferase (ALT), γ-glutamyl transpeptidase (γGT), uric acid, triglycerides, and insulin, were significantly different between the two groups (all p<0.05) as determined using homeostatis model assessment of insulin resistance (HOMA-IR). In our multivariate logistic regression analysis, elevated serum ALT, γGT, and triglyceride levels were significantly related to NAFLD development. The nomogram was established using γGT, uric acid, triglycerides, HOMA-IR, and ALT as predictors of NAFLD probability. Conclusion: The newly developed nomogram may help predict NAFLD risk in obese children. The nomogram may also allow for early NAFLD diagnosis without the need for invasive liver biopsy or expensive liver imaging, and may also allow clinicians to intervene early to prevent the progression of NAFLD to become a more advanced liver disease.
참고문헌 (36)
- Schwimmer JB, "Prevalence of fatty liver in children and adolescents", Pediatrics, 118, pp.1388~1393 (2006)
- Wieckowska A, "Nonalcoholic fatty liver disease in the pediatric population : a review", Curr Opin Pediatr, 17, pp.636~641 (2005)
- Anderson EL, "The prevalence of non-alcoholic fatty liver disease in children and adolescents : a systematic review and meta-analysis", PLoS One, 10, pp.e0140908~ (2015)
- Chalasani N, "The diagnosis and management of non-alcoholic fatty liver disease : Practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association", Am J Gastroenterol, 107, pp.811~826 (2012)
- Feldstein AE, "The natural history of non-alcoholic fatty liver disease in children : a follow-up study for up to 20 years", Gut, 58, pp.1538~1544 (2009)
- Molleston JP, "Obese children with steatohepatitis can develop cirrhosis in childhood", Am J Gastroenterol, 97, pp.2460~2462 (2002)
- Kistler KD, "Symptoms and quality of life in obese children and adolescents with non-alcoholic fatty liver disease", Aliment Pharmacol Ther, 31, pp.396~406 (2010)
- Estrada E, "Children's Hospital Association consensus statements for comorbidities of childhood obesity", Child Obes, 10, pp.304~317 (2014)
- Socha P, "International hepatology updates: liver diseases in children", pp.147~161 (2009), Perlmayer
- De Bruyne RM, "Fatty liver disease in children : eat now pay later", Hepatol Int, 4, pp.375~385 (2010)
- Wieckowska A, "Noninvasive diagnosis and monitoring of nonalcoholic steatohepatitis : present and future", Hepatology, 46, pp.582~589 (2007)
- Jae Sung Ko, "New Perspectives in Pediatric Nonalcoholic Fatty Liver Disease: Epidemiology, Genetics, Diagnosis, and Natural History", Pediatric Gastroenterology, Hepatology & Nutrition, 22(6), pp.501~510 (2019), 대한소아소화기영양학회[DOI]
- Strauss S, "Interobserver and intraobserver variability in the sonographic assessment of fatty liver", AJR Am J Roentgenol, 189, pp.W320~3 (2007)
- 문진수, "2007 한국 소아 청소년 성장도표 : 개발 과정과 전망", Clinical and Experimental Pediatrics, 51(1), pp.1~25 (2008), 대한소아청소년과학회
- Matthews DR, "Homeostasis model assessment : insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man", Diabetologia, 28, pp.412~419 (1985)
- Grundy SM, "Diagnosis and management of the metabolic syndrome : an American Heart Association", National Heart, Lung, and Blood Institute Scientific Statement, 2005, pp.112, 2735~2752
- Saadeh S, "The utility of radiological imaging in nonalcoholic fatty liver disease", Gastroenterology, 123, pp.745~750 (2002)
- Celle G, "Is hepatic ultrasonography a valid alternative tool to liver biopsy? Report on 507 cases studied with both techniques", Dig Dis Sci, 33, pp.467~471 (1988)
- Yoshizumi T, "Abdominal fat : standardized technique for measurement at CT", Radiology, 211, pp.283~286 (1999)
- Alisi A, "Pediatric nonalcoholic fatty liver disease in 2009", J Pediatr, 155, pp.469~474 (2009)
- Booth ML, "The population prevalence of adverse concentrations and associations with adiposity of liver tests among Australian adolescents", J Paediatr Child Health, 44, pp.686~691 (2008)
- Green RM, "AGA technical review on the evaluation of liver chemistry tests", Gastroenterology, 123, pp.1367~1384 (2002)
- Schwimmer JB, "Histopathology of pediatric nonalcoholic fatty liver disease", Hepatology, 42, pp.641~649 (2005)
- Manco M, "Risk of severe liver disease in NAFLD with normal ALT levels : a pediatric report", Hepatology, 48, pp.2087~2088 (2008)
- Tahan V, "Serum gamma-glutamyltranspeptidase distinguishes non-alcoholic fatty liver disease at high risk", Hepatogastroenterology, 55, pp.1433~1438 (2008)
- Baldwin W, "Hyperuricemia as a mediator of the proinflammatory endocrine imbalance in the adipose tissue in a murine model of the metabolic syndrome", Diabetes, 60, pp.1258~1269 (2011)
- Assy N, "Fatty infiltration of liver in hyperlipidemic patients", Dig Dis Sci, 45, pp.1929~1934 (2000)
- Utzschneider KM, "Review : the role of insulin resistance in nonalcoholic fatty liver disease", J Clin Endocrinol Metab, 91, pp.4753~4761 (2006)
- Min-Su Oh, "Associations among the Degree of Nonalcoholic Fatty Liver Disease, Metabolic Syndrome, Degree of Obesity in Children, and Parental Obesity", Pediatric Gastroenterology, Hepatology & Nutrition, 19(3), pp.199~206 (2016), 대한소아소화기영양학회
- Sheth SG, "AST", ALT ratio predicts cirrhosis in patients with chronic hepatitis C virus infection, 1998, pp.93, 44~48
- Angulo P, "Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis", Hepatology, 30, pp.1356~1362 (1999)
- Kruger FC, "APRI : a simple bedside marker for advanced fibrosis that can avoid liver biopsy in patients with NAFLD", NASH, 2011, pp.101, 477~480
- Angulo P, "The NAFLD fibrosis score : a noninvasive system that identifies liver fibrosis in patients with NAFLD", Hepatology, 45, pp.846~854 (2007)
- Sterling RK, "Development of a simple noninvasive index to predict significant fibrosis in patients with HIV", HCV coinfection, 2006, pp.43, 1317~1325
- Shah AG, "Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease", Clin Gastroenterol Hepatol, 7, pp.1104~1112 (2009)
- Jackson JA, "Performance of fibrosis prediction scores in paediatric non-alcoholic fatty liver disease", J Paediatr Child Health, 54, pp.172~176 (2018)