Pediatr Gastroenterol Hepatol Nutr.  2016 Sep;19(3):199-206. 10.5223/pghn.2016.19.3.199.

Associations among the Degree of Nonalcoholic Fatty Liver Disease, Metabolic Syndrome, Degree of Obesity in Children, and Parental Obesity

• Oh MS
• Kim S
• Jang JH
• Park JY
• Kang HS
• Lee MS
• Kang KS

• KMID: 2364779
• DOI: http://doi.org/10.5223/pghn.2016.19.3.199

Abstract

PURPOSE
To analyze the associations among the degrees of nonalcoholic fatty liver disease (NAFLD) by ultrasonography and metabolic syndrome, degrees of obesity in children, and degrees of parental obesity.
METHODS
A total of 198 children with obesity who visited a pediatric obesity clinic were prospectively enrolled in this study. The severity of NAFLD based on ultrasonography was classified into no, mild, moderate, or severe NAFLD group. The degree of obesity based on the percentage over standard weight for height per sex was classified into mild, moderate, or severe.
RESULTS
Of 132 patients evaluated for the degree of NAFLD and metabolic syndrome, the p-value of correlation between the two factors was 0.009. Therefore, metabolic syndrome might significantly affect the degree of NAFLD. Of 158 patients evaluated for the degree of NAFLD and the degree of obesity, the p-value of correlation between the two factors was 0.122. Of 154 patients evaluated for the degree of obesity and father's obesity, the p-value was 0.076. Of 159 patients evaluated for the degree of obesity and mother's obesity, the p-value was 0.000, indicating that mother's obesity could significantly affect the degree of obesity in children. Of 142 patients evaluated for the degree of obesity and metabolic syndrome, the p-value was 0.288.
CONCLUSION
Metabolic syndrome might significantly affect the degree of nonalcoholic fatty liver in children. In addition, mother's obesity might be a significant factor that affects the degree of obesity in children.

Keyword

Obesity; Child; Non-alcoholic fatty liver disease; Metabolic syndrome

MeSH Terms

Child*
Humans
Non-alcoholic Fatty Liver Disease*
Obesity*
Parents*
Pediatric Obesity
Prospective Studies
Ultrasonography

Figure

• 

  Fig. 1 Diagram of study design. The objective of this study was to analyze the associations among the degrees of nonalcoholic fatty liver disease (NAFLD) by ultrasonography and metabolic syndrome, degrees of obesity in children, and degrees of parental obesity. *The weight for height per sex at more than 120%. †Likelihood-ratio χ2 test.

• 

  Fig. 2 The relationship between the degree of obesity in children and parental obesity. Father's obesity percentage according to the degree of obesity in children (A) tended to be higher in the group with more severe degree of obesity. However, it was not significant (p=0.076, likelihood-ratio χ2 test). Mother's obesity percentage according to the degree of obesity in children (B) was higher in the group with more severe degree of obesity (p=0.000, likelihood-ratio χ2 test). Both parental obesity percentages (C) were higher in the group with more severe degree of obesity (p=0.004, likelihood-ratio χ2 test).

• 

  Fig. 3 The percentage of metabolic syndrome combined to the degree of obesity or the degree of nonalcoholic fatty liver disease (NAFLD). The percentage of metabolic syndrome combined to the degree of obesity (A) was not increased according to the increase in the degree of obesity (p=0.288, likelihood-ratio χ2 test). The percentage of metabolic syndrome combined to the degree of NAFLD (B) was higher in the group with more severe degree of NAFLD (p=0.005, likelihood-ratio χ2 test), even though the percentage between moderate and severe NAFLD was reversed.

• 

  Fig. 4 Relationship between the degree of obesity and the degree of nonalcoholic fatty liver disease (NAFLD). There was no significant change in the degree of NAFLD according to the degree of obesity (p=0.573, likelihood-ratio χ2 test).

Reference

1. Korean Education Ministry. The results for school health examination survey 2014 [Internet]. Sejong: Korean Education Ministry;2015. cited 2015 Feb 12. Available from: http://www.moe.go.kr/web/106888/ko/board/view.do?bbsId=339&boardSeq=58466.

2. Keane VA. Assessment of growth. In : Kliegman RM, Stanton BF, St Geme JW, Schor NF, Behrman RE, editors. Nelson textbook of pediatrics. 20th ed. Philadelphia: Elsevier;2015.

3. Wieckowska A, Feldstein AE. Nonalcoholic fatty liver disease in the pediatric population: a review. Curr Opin Pediatr. 2005; 17:636–641.

4. Feldstein AE, Charatcharoenwitthaya P, Treeprasertsuk S, Benson JT, Enders FB, Angulo P. The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years. Gut. 2009; 58:1538–1544.

5. Patton HM, Sirlin C, Behling C, Middleton M, Schwimmer JB, Lavine JE. Pediatric nonalcoholic fatty liver disease: a critical appraisal of current data and implications for future research. J Pediatr Gastroenterol Nutr. 2006; 43:413–427.

6. Patton HM, Yates K, Unalp-Arida A, Behling CA, Huang TT, Rosenthal P, et al. Association between metabolic syndrome and liver histology among children with nonalcoholic Fatty liver disease. Am J Gastroenterol. 2010; 105:2093–2102.

7. Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997; 337:869–873.

8. Saadeh S, Younossi ZM, Remer EM, Gramlich T, Ong JP, Hurley M, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology. 2002; 123:745–750.

9. Lambert M, Paradis G, O'Loughlin J, Delvin EE, Hanley JA, Levy E. Insulin resistance syndrome in a representative sample of children and adolescents from Quebec, Canada. Int J Obes Relat Metab Disord. 2004; 28:833–841.

10. Yoo S, Lee SY, Kim KN, Sung E. Obesity in Korean pre-adolescent school children: comparison of various anthropometric measurements based on bioelectrical impedance analysis. Int J Obes (Lond). 2006; 30:1086–1090.

11. Ahn YM, Sohn M, Choi SH. Comparison in weight, height, degree of obesity and body mass index among different methods for body shape classification in school-age children. J Korean Acad Nurs. 2010; 40:775–784.

12. Vajro P, Lenta S, Socha P, Dhawan A, McKiernan P, Baumann U, et al. Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr. 2012; 54:700–713.

13. Roldan-Valadez E, Favila R, Martínez-López M, Uribe M, Méndez-Sánchez N. Imaging techniques for assessing hepatic fat content in nonalcoholic fatty liver disease. Ann Hepatol. 2008; 7:212–220.

14. Nobili V, Vizzutti F, Arena U, Abraldes JG, Marra F, Pietrobattista A, et al. Accuracy and reproducibility of transient elastography for the diagnosis of fibrosis in pediatric nonalcoholic steatohepatitis. Hepatology. 2008; 48:442–448.

15. Joseph AE, Saverymuttu SH, al-Sam S, Cook MG, Maxwell JD. Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease. Clin Radiol. 1991; 43:26–31.

16. Park SH, Kim PN, Kim KW, Lee SW, Yoon SE, Park SW, et al. Macrovesicular hepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment. Radiology. 2006; 239:105–112.

17. Radetti G, Kleon W, Stuefer J, Pittschieler K. Non-alcoholic fatty liver disease in obese children evaluated by magnetic resonance imaging. Acta Paediatr. 2006; 95:833–837.

18. Pacifico L, Celestre M, Anania C, Paolantonio P, Chiesa C, Laghi A. MRI and ultrasound for hepatic fat quantification: relationships to clinical and metabolic characteristics of pediatric nonalcoholic fatty liver disease. Acta Paediatr. 2007; 96:542–547.

19. Mencin AA, Lavine JE. Nonalcoholic fatty liver disease in children. Curr Opin Clin Nutr Metab Care. 2011; 14:151–157.

20. Loomba R, Sirlin CB, Schwimmer JB, Lavine JE. Advances in pediatric nonalcoholic fatty liver disease. Hepatology. 2009; 50:1282–1293.

21. Sundaram SS, Zeitler P, Nadeau K. The metabolic syndrome and nonalcoholic fatty liver disease in children. Curr Opin Pediatr. 2009; 21:529–535.

22. Park SK, Ryoo JH, Choi JM, Seo MW, Park CM. The risk of abdominal obesity according to the degree of non-alcoholic fatty liver disease in Korean men. J Korean Med Sci. 2016; 31:410–416.

23. Etelson D, Brand DA, Patrick PA, Shirali A. Childhood obesity: do parents recognize this health risk? Obes Res. 2003; 11:1362–1368.

24. Golan M, Weizman A, Apter A, Fainaru M. Parents as the exclusive agents of change in the treatment of childhood obesity. Am J Clin Nutr. 1998; 67:1130–1135.

25. Chang JH, Kim DH, Kim HS, Choi IK, Cheong MY, Kim DK. Prevalence of metabolic syndrome in obese children. Korean J Pediatr. 2004; 47:1149–1156.