Non-alcoholic fatty liver disease in children: relationship with the main components of metabolic syndrome in children
Authors: Bokova T. A. 
Published: May 2020

There is a high frequency of combination of components of metabolic syndrome (MS) and liver damage in obese patients.Of interest is the study of clinical and pathogenetic relationships between the morphofunctional state of the liver and the development of MS in children.

Objective: to Study the functional state of the liver in children with MS and to assess the relationship with its main components.

Materials and methods. 483 obese children (SDS BMI≥2.0) aged from 5 to 16 years (285 boys and 198 girls) were examined: I gr. — 237 children with MS, II gr. — 246 obese children without MS. Comprehensive examination included anamnesis, anthropometry, clinical and biochemical blood tests, lipid spectrum and carbohydrate metabolism, ultrasound examination of the abdominal cavity and retroperitoneal space, CT of the abdominal cavity. Statistical processing of the results was carried out using the package «STATISTIKA 6.0».

Research result. Ultrasound-signs of nonalcoholic fatty liver disease (NAFD) in I gr. revealed significantly more often than in II gr. (166 — 70% and 125 — 51%, respectively, p<0.05). The majority (91%) of children with NAFD are 10–16 years old. Boys slightly more than girls (58% and 42%). The increase of ALT in the I gr. it was registered at 27% of children, in II gr. — in 18% of children (p<0.05). Increase of ALT in boys was detected 2 times more often than in girls (26% and 13%, p<0.05). In patients with NAFLD, regardless of the group, signs of atherogenic dyslipidemia (increased triglycerides, decreased HDL), impaired carbohydrate metabolism (insulin, C‑peptide and IR index) were more often diagnosed. A higher frequency of hyperglycemia in children I gr. was established. regardless of the liver condition (68% of children without NAFLD and 69% of children with NAFLD), whereas in II gr. it was registered more often in the presence of NAFLD (16% and 8%). In both groups, the level of MC in children with NAFLD was higher than without it, and in I gr. this indicator was significantly higher than in children of II gr. Mean fibrinogen levels were also higher in children with NAFLD, and these differences were significantly significant in I gr.

Conclusion.

1. Ultrasound criteria for NAFLD in children with MS are diagnosed significantly more often (70%) than in children with uncomplicated obesity (51%).

2. CT-changes in liver parenchymain NAFLD are characterized by the presence of diffuse focal process with the presence of different sites with changes in the type of fatty dystrophy and steatohepatitis against the background of unchanged parenchyma.

3. Adolescents over 12 years of age and males predominate among children with NAFLD.

4. Waist circumference in children with NAFLD, regardless of the group, significantly exceeds that of children without it, which indicates the relationship of functional disorders of the liver with the development of abdominal type

of obesity — the main component of MS.

5. Hyperfermentemia in the form of increased ALT levels is most often registered in children with MS in the presence of NAFLD (27%), in 15% of them the values exceed the normative indicators by 1.5 or more times, which indicates a high risk of developing an inflammatory process of the type of steatohepatitis.

6. Lipid metabolism disorders in the form of an increase in TG and a decrease in HDL in children with NAFLD are recorded more often than in children without it, regardless of the presence of MS, but their combination is diagnosed exclusively in children with MS: in children with NAFLD — in 29% of cases, without it — in 23%.

7. Regardless of the group, changes in carbohydrate metabolism in the presence of NAFLD were more pronounced than in children without it, while children with MS and NAFLD showed a more significant increase in glycemia, insulin and IR index.

8. Children with MS and NAFLD have a higher incidence of purine metabolism disorders.

9. A correlation between hepatic metabolism and disorders in the fibrinolysis system, which progress with the duration of the disease, was obtained.