Abstract P380: Obesity and Non-Alcoholic Fatty Liver Disease in Children
The increasing prevalence of childhood obesity has been well documented and is predictive of an increased severity in obesity-related CVD risk factors and metabolic disorders, such as non-alcoholic fatty liver disease (NAFLD). This study determined the association between obesity and risk for altered liver function and NAFLD in 12,476 children (≤18 years) enrolled in the C8 Health Project, which resulted from pretrial settlement of a class action lawsuit pursuant to contamination of the drinking water supply (Frisbee et al, 2009). In this population, 48% were female, median age and BMI percentile were 11.6 years and 76, respectively, with 39.8% classified as overweight (OWT) or obese (OB). Seven serum biomarkers of liver function (ALT, AST, total (bili-t) & direct (bili-d) bilirubin, alkaline phosphatase (AlkPhos), GGT, & lactate dehydrogenase (LDH)) were available for 10,543 children. Based on prior categorization (Schwimmer et al, 2005), ALT or AST≥40IU/L were considered indicative of NAFLD. In linear regression adjusted for age, gender, SES (socio-economic status) and non-HDL cholesterol, BMI (z score) was significantly associated with all liver biomarkers (b coefficient±SE/adj R-square): ALT (1.6±0.1/6.6%); AST (-0.3±0.1/17.8%); bili-d (-0.002±0.0004/16.8%); bili-t (-0.01±0.002/9.4%); AlkPhos (-4.3±0.8/27.7%); GGT (1.0±0.1/18.0%); LDH (2.4±0.3/44.6%). Results for logistic regression assessing for NAFLD risk based on OWT or OB are shown Table 1. Overall, there was a stronger association between NAFLD risk with increasing BMI for ALT compared to AST (2-6 fold compared to insignificant risk). This pattern was similar for girls and boys. Interestingly, age stratified analysis revealed that obesity was slightly protective from AST-defined NAFLD in younger age groups, but this reversed in older ages. OWT and OB were associated with increased ALT-defined NAFLD, particularly in older ages. These results suggest a complex, non-linear and age-dependent association between obesity and NAFLD in children.
|OR (95%CI) for ALT >=40 IU/L||OR (95% CI) for AST >=40 IU/L|
|Total Population||OWT: 2.0 (1.3-3.0)/OB: 5.9 (4.2-8.1)||NSS|
|Gender Stratified||Female||OWT: 2.2 (1.2-4.3)/OB: 4.7 (2.7-8.1)||NSS|
|Male||OWT: 1.9 (1.1-3.3)/OB: 6.6 (4.4-10.0)||NSS|
|Age Group Stratified||< 5 Yrs||NSS||OWT: 0.2 (0.1-0.7)/OB: 0.3 (0.1-0.5)|
|5-9.9 Yrs||OWT: NSS/OB: 3.6 (1.3-9.9)||OWT: NSS/OB: 0.5 (0.3-0.9)|
|10-14.9 Yrs||OWT: NSS/OB: 7.0 (4.3-11.1)||OWT: NSS/OB: 2.4 (1.4-4.1)|
|15-17.9 Yrs||OWT: 2.2 (1.2-4.0)/OB: 5.3 (3.2-8.6)||NSS|
Models adjusted for age (except age stratified), gender (except gender stratified), SES,&non-HDL c
- © 2012 by American Heart Association, Inc.