The association of elevated alanine aminotransferase and the metabolic syndrome in an overweight and obese pediatric population of multi-ethnic origin

Vliet, Mariska van; Rosenstiel, Inès A. von; Schindhelm, Roger K.; Brandjes, D.P.M.; Beijnen, Jos H.; Diamant, Michaëla

doi:10.1007/s00431-008-0802-2

Cited by 35 publications

(40 citation statements)

References 28 publications

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“…Thus, we hypothesize that insulin resistance has not started yet in our patients groups. We found lower adiponectin levels in our patients and this is consistent with previous studies [4,33]. Previous studies suggest that hypoadiponectinemia might be involved in the development of FLD [4,24].…”

Section: Discussionsupporting

confidence: 95%

“…At the same time, low HDL-C level is an independent predictor for presence of FL. Low HDL levels were highly associated with the metabolic syndrome, insulin resistance, and high triglycerides in obese children and adolescents in recent studies [33,36]. High risk of FL, in our Doppler US group, was associated with alterations in lipid metabolism but not with glucose metabolism in overweight and obese adolescents.…”

Section: Discussionmentioning

confidence: 58%

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Metabolic predictors for early identification of fatty liver using doppler and B-mode ultrasonography in overweight and obese adolescents

et al. 2010

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(1) to evaluate the frequency of asymptomatic fatty liver disease (FLD) using both Doppler and B-mode ultrasound (US) in overweight and obese adolescents; (2) to compare metabolic findings of fatty liver (FL) assessed by two methods; and (3) to evaluate metabolic predictors of FL shown by these methods. Fifty-nine overweight and obese adolescents aged between 9.0 and 17.0 years and 41 non-obese healthy adolescents were included in this study. B-mode and right hepatic vein Doppler ultrasonography (US) were performed and anthropometric indices, lipid profiles, and adiponectin levels were evaluated in all adolescents. HDL-C levels were significantly lower in patients with FL detected by Doppler US compared to patients without FL (p < 0.05). HDL-C levels were inversely correlated with presence of FL assessed by two methods (r = -0.285, p = 0.004; r = -0.328, p = 0.001, respectively) and adiponectin levels were correlated with presence of FL only detected by B-mode US (r = -0.263, p = 0.008). Adiponectin levels were significantly lower in patients with FL than those without FL assessed by B-Mode US (p = 0.049). Multiple regression analysis revealed that HDL-C levels was the most important predictor of FL assessed by Doppler US (p = 0.027), while body mass index was the determinant of FL assessed by two methods (p < 0.001) in asymptomatic overweight and obese adolescents. It was found that FLD, identified by both B-mode and Doppler US, is seen frequently in asymptomatic overweight and obese adolescents. Elevated BMI is associated with increased risk of FL assessed by two ultrasonographic methods. When using Doppler US, low HDL-C levels can be used as a good predictor for presence of FLD in overweight and obese adolescents.

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Section: Discussionsupporting

confidence: 95%

Section: Discussionmentioning

confidence: 58%

Metabolic predictors for early identification of fatty liver using doppler and B-mode ultrasonography in overweight and obese adolescents

et al. 2010

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“…On the basis of the German guidelines for diagnosis and treatment of OW children and adolescents, 13 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].98 years, 58% males) were examined and evaluated at one of the participating centers for being OW or ob, and their initial measurement of liver enzymes were also recorded. The weight status was recorded as body mass index (BMI).…”

Section: Methodsmentioning

confidence: 99%

Obese boys at increased risk for nonalcoholic liver disease: evaluation of 16 390 overweight or obese children and adolescents

et al. 2010

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Objective: Comorbidities of childhood obesity challenge health-care systems in Europe. Further, there is a lack of populationspecific prevalence data and diagnostic strategies available, especially for obesity-related disturbances of liver function. Therefore, the prevalence of elevated liver enzymes and their relationship to biological parameters were studied in a large pediatric obesity cohort. Methods: In 111 specialized pediatric obesity centers in Germany, Austria and Switzerland, 16 390 children and adolescents (age 12.4 ± 2.6 years, 58% boys) were categorized as overweight (body mass index (BMI) 490th percentile) and obese (497th percentile) and studied for related comorbidities, especially nonalcoholic fatty liver disease (NAFLD; as defined by aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) 450 U l À1 ). Data were collected using a standardized software program (APV) for longitudinal multicenter documentation. Pseudonymized data were transmitted for central statistical analysis. Results: In this pediatric cohort, 16% of the study population was overweight, 46% obese and 35% extremely obese (499.5th percentile extreme obesity (Xob)). NAFLD was present in 11% of the study population, but predominantly in boys (boys vs girls; 14.4:7.4%; Po0.001), in Xob (obese vs Xob; 9.5:17.0%; Po0.001) and in older age (o 12 vs X12 years; 8:12%; Po0.001; adjusted for BMI). ALT 450 U l À1 was significantly associated with fasting insulin and BMI-SDS. In multiple logistic regression models, Xob and male gender were strongly associated with NAFLD (odds ratio Xob vs normal weight ¼ 3.2; boys vs girls OR ¼ 2.3). Conclusion: In a large cohort of overweight and obese European children and adolescents, markers of nonalcoholic liver disease, especially ALT, are frequent and predicted by Xob and male gender. The results underline the epidemiological dimension of this obesity-related morbidity even in childhood. Therefore, at least ALT is recommended as a screening parameter in basic care.

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“…The notion that hepatic inflammation by itself is atherogenic is supported by the observation that CV disease is strongly associated with elevated alanine aminotransferase and γ-glutamyltransferease, which are surrogate markers of liver necroinflammation [95–97]. Two large pediatric studies showed an association between elevated serum alanine transaminase levels and the prevalence of the MS and IR as markers of CV risk in obese children aged 3–18 years [98,99]. Longitudinal studies are needed to assess the development of adulthood CV disease in these children with abnormal liver enzymes and other risk factors for atherosclerosis.…”

Section: Nafld and Systemic Inflammationmentioning

confidence: 99%

Atherogenic dyslipidemia and cardiovascular risk in children with nonalcoholic fatty liver disease

Alkhouri

Carter–Kent

Elias

et al. 2011

Clinical Lipidology

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Nonalcoholic fatty liver disease is now regarded as the most common form of chronic liver disease in adults and children. The close association between nonalcoholic fatty liver disease (NAFLD) and the metabolic syndrome has been extensively described. Moreover, a growing body of evidence suggest that NAFLD by itself confers a substantial cardiovascular risk independent of the other components of the metabolic syndrome. Given the significant potential for morbidity and mortality in these patients, and the large proportion of both pediatric and adult population affected, it is important that we clearly define the overall risk, identify early predictors for cardiovascular disease progression, and establish management strategies. In this article, we will focus on current data linking NAFLD and the severity of liver damage present in children with cardiovascular risk.

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The association of elevated alanine aminotransferase and the metabolic syndrome in an overweight and obese pediatric population of multi-ethnic origin

Cited by 35 publications

References 28 publications

Metabolic predictors for early identification of fatty liver using doppler and B-mode ultrasonography in overweight and obese adolescents

Metabolic predictors for early identification of fatty liver using doppler and B-mode ultrasonography in overweight and obese adolescents

Obese boys at increased risk for nonalcoholic liver disease: evaluation of 16 390 overweight or obese children and adolescents

Atherogenic dyslipidemia and cardiovascular risk in children with nonalcoholic fatty liver disease

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