Yonsei Med J.  2017 Jul;58(4):756-762. 10.3349/ymj.2017.58.4.756.

Pathologic Impact of Insulin Resistance and Sensitivity on the Severity of Liver Histopathology in Pediatric Non-Alcoholic Steatohepatitis

• Park BH
• Yoon JM
• Kim JH
• Moon JH
• Lee YH
• Jang SM
• Kim YJ

• KMID: 2419081
• DOI: http://doi.org/10.3349/ymj.2017.58.4.756

Abstract

PURPOSE
Insulin resistance (IR) has an important role in the development of non-alcoholic steatohepatitis (NASH). We aimed to analyze the association between liver histopathology and IR in pediatric patients with NASH.
MATERIALS AND METHODS
In 24 children with non-alcoholic fatty liver disease (NAFLD), we investigated whether the hepatic pathologic characteristics have relations with following three biochemical indices; IR index including homeostasis model assessment of IR (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and insulin sensitivity indices-free fatty acid (ISI-FFA).
RESULTS
Among 24 patients, 16 (66.6%) had a high NAFLD activity score (NAS), which is diagnostic of NASH. Higher serum triglyceride level was significantly correlated with a high NAS. Higher steatosis grades were significantly associated with low insulin sensitivity (p=0.023). In addition, severe lobular inflammation was associated with higher IR: HOMA-IR (p=0.014) and QUICKI (p=0.023). Severe fibrosis correlated with low insulin sensitivity and high IR indexes: ISI-FFA (p=0.049), HOMA-IR (p=0.028), and QUICKI (p=0.007).
CONCLUSION
Patients with high IR had more severe lobular inflammation and hepatic fibrosis. Analyses of biochemical and endocrine parameters can be applied to determine the severity of the hepatic pathologic status in patients with NASH, especially in children who cannot undergo a liver biopsy.

Keyword

Nonalcoholic steatohepatitise; childrene; liver biopsy; insulin resistance

MeSH Terms

Adolescent
Anthropometry
Child
Female
Humans
*Insulin Resistance
Liver/*pathology
Male
Non-alcoholic Fatty Liver Disease/*pathology
*Severity of Illness Index

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