Increased liver echogenicity and liver enzymes are associated with extreme obesity, adolescent age and male gender: analysis from the German/Austrian/Swiss obesity registry APV

Abstract

Background Childhood obesity is often associated with non-alcoholic fatty liver disease (NAFLD), the most common chronic liver disease in pediatrics. Methods This multi-center study analyzed liver echogenicity and liver enzymes in relation to obesity, age, gender and comorbidities. Data were collected using a standardized documentation software (APV) from 1.033 pediatric patients (age: 4–18 years, body mass index = BMI: 28–36 kg/m2, 50% boys) with overweight (BMI >90th percentile), obesity (BMI >97th percentile) or extreme obesity (BMI > 99.5th percentile) and obesity related comorbidities, especially NAFLD from 26 centers of Germany, Austria and Switzerland. Liver enzymes aspartate aminotransferase (AST), alanine-aminotransferase (ALT) and gamma glutamyltransferase (gammaGT) were evaluated using 2 cut-off values a) > 25 U/L and b) > 50 U/L. Multiple logistic regression models were used for statistical analysis. Results In total, 44% of the patients showed increased liver echogenicity. Liver enzymes > 25 U/L were present in 64% and > 50 U/L in 17%. Increased liver echogenicity was associated with elevated liver enzymes (> 25 U/L: odds ratio (OR) = 1.4, 95% CI: 1.1–1.9, P < 0.02; > 50 U/L: OR = 3.5, 95% CI: 2.4–5.1, P < 0.0001). Extreme obesity, adolescence and male gender were associated with increased liver echogenicity (extreme obesity vs overweight OR = 3.5, 95% CI: 1.9–6.1, P < 0.0001; age > 14 years vs age < 9 years OR = 2.2, 95% CI: 1.4–3.5, P < 0.001; boys vs girls OR = 1.6, 95% CI: 1.2–2.0, P < 0.001) and elevated liver enzymes (extreme obesity vs overweight > 25 U/L: OR = 4.1, 95% CI: 2.4–6.9, P < 0.0001; > 50 U/L: OR = 18.5, 95% CI: 2.5–135, P < 0.0001; age > 14 years vs age < 9 years > 50 U/L: OR = 1.9, 95% CI: 1.0–3.7, P > 0.05; boys vs girls > 25 U/L: OR = 3.1, 95% CI: 2.4–4.1, P < 0.0001; > 50 U/L: OR = 2.1, 95% CI: 1.5–2.9, P < 0.0001). Impaired glucose metabolism showed a significant correlation with elevated liver enzymes > 50 U/L (OR = 4.4, 95% CI: 1.6–11.8, P < 0.005). Arterial hypertension seemed to occur in patients with elevated liver enzymes > 25 U/L (OR 1.6, 95% CI: 1.2–2.0, P < 0.005). Conclusions NAFLD is strongly related to extreme obesity in male adolescents. Moreover impaired glucose tolerance was observed in patients with elevated liver enzymes > 50 U/L, but arterial hypertension was only present in patients with moderately elevated liver enzymes > 25 U/L.

Prevalence of increased transaminases and its association with sex, age, and metabolic parameters in children and adolescents with obesity – a nationwide cross-sectional cohort study

“…In accordance with other studies [15,16], the present study found a dose-response association between the degree of obesity and increased ALT among children and adolescents with obesity. Moreover, we have been able to show that the dose-response association is stronger in markedly increased ALT compared to mildly increased ALT.…”

“…Although several studies have investigated the association of elevated ALT with age and sex among children and adolescents with obesity [15,16,33], previous studies did not take sex-age interaction into account in the analyses. The present study confirms that both sex and age are independently associated with elevated ALT.…”

“…In addition, previous studies assessing the association of pediatric NAFLD with impaired fasting glucose and dyslipidemia have demonstrated inconsistent results. A population-based and some hospital-based studies in children and adolescents with obesity found associations of NAFLD with impaired fasting glucose [19][20][21] and all dyslipidemia components [22], yet other studies detected neither association of NAFLD with impaired fasting glucose [15] nor with all dyslipidemia components [21,23]. Identifying which children and adolescents with obesity that is having the greatest risk of NAFLD is important since early detection and prompt treatment of NAFLD in this high-risk population can be effective to prevent progression and reverse the disease [8].…”

“…The majority of children and adolescents with obesity do not have NAFLD [13,14]. Among children and adolescent with obesity, males and adolescent age have been reported to be independent risk factors of NAFLD [11,15,16]. However, the presence of interaction effect between sex and age on pediatric NAFLD has not been investigated, whereas this interaction has been known to modulate NAFLD risk in adults with obesity [17,18].…”

Оценка Состояния Интестинальной Микрофлоры И Содержания Короткоцепочечных Жирных Кислот Копрофильтрата У Детей С Неалкогольной Жировой Болезнью Печени

“…The development of NAFLD is highly dependent on age, gender and ethnicity [4]. Fatty liver in adolescents is more common than in young children and is twice more frequent in boys than in girls [5,6]. Unfortunately, despite considerable progress in understanding the complexity of the disease, the pathophysiological mechanisms involved in the onset and progression of liver damage in paediatric NAFLD remain unclear [2].…”