Abstract OBJECTIVE: To quantitatively evaluate clinical significance of intrahepatic fat (IHF) content in children and adolescents with non-alcoholic fatty liver disease (NAFLD). METHODS: Ninety-three obese children were enrolled in this study. Physical parameters, liver function, serum lipids, glycemic and insulin related parameters were measured. Liver B-mode ultrasound (US) examination was performed. IHF content was quantified by 1H magnetic resonance spectroscopy (1H MRS). Three subgroups were classified according to the conditional diagnostic criteria for obese children: simple obesity (n=31), NAFLD-1 (US fatty liver and normal alanine aminotransterase, n=33) and NAFLD-2 (US fatty liver and elevated alanine aminotransterase, n=29). Twenty healthy age- and sex-matched children served as a control group. IHF content among the four groups was compared. The relationship of IHF content with other common clinical laboratory parameters and independent factors influencing increased IHF content were investigated. RESULTS: IHF content measured by 1H MRS was 0.80% (0.4%-1.0%), 2.9% (1.7%-4.30%), 14.0% (7.2%-17.5%) and 18.8% (14.0%-29.1%) respectively in the control, simple obese, NAFLD-1 and NAFLD-2 groups. There were significant differences in IHF content between the groups. Univariate correlation analysis demonstrated that IHF content was positively correlated with waist circumference, hip circumference, waisttohip ratio, body mass index, systolic blood pressure, diastolic blood pressure, alanine aminotransferase, aspartate aminoreansferase, γ-glutamic acid transtetase, triglyceride, low-density lipoprotein, OGTT 2-hour plasma glucose, fasting insulin, 2-hour insulin and insulin resisfence, and negatively correlated with high-density lipoprotein. Multivariate linear regression analysis demonstrated three independent risk factors for increased IHF content: increased waist circumference, increased 2-hour plasma glucose and decreased high-density lipoprotein levels. CONCLUSIONS: IHF content determined by 1H MRS can reflect early hepatic fatty infiltration and is closely related to the occurrence and progress of NAFLD in obese children and adolescents. There is a significant correlation between most of common clinical laboratory parameters and IHF content, and waist circumference, high-density lipoprotein and OGTT 2-hour plasma glucose are independent factors impacting IHF content.
ZHANG Hong-Xi,FU Jun-Fen,HUANG Ke et al. Quantitative assessment of intrahepatic fat content in children and adolescents with nonalcoholic fatty liver disease[J]. 中国当代儿科杂志, 2012, 14(08): 598-603.
ZHANG Hong-Xi,FU Jun-Fen,HUANG Ke et al. Quantitative assessment of intrahepatic fat content in children and adolescents with nonalcoholic fatty liver disease[J]. CJCP, 2012, 14(08): 598-603.
［1］Grant LM, LiskerMelman M. Nonalcoholic fatty liver disease［J］. Ann Hepatol, 2004, 3(3): 93-99.
［2］Powell EE, Cooksley WG, Hanson R, Searle J, Halliday JW, Powell LW. The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years［J］. Hepatology, 1990, 11(1): 74-80.
［3］Carter- Kent C, Brunt EM, Yerian LM, Alkhouri N, Anqulo P, Kohli R, et al. Relations of steatosis type, grade, and zonality to histological features in pediatric nonalcoholic fatty liver disease ［J］. J Pediatr Gastroenterol Nutr, 2011, 52(2):190-197.
［6］Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling［J］. Diabetes Care, 2004, 27(6): 1487-1495.
［7］Longo R, Pollesello P, Ricci C, Masutti F, Kvam BJ, Bercich L, et al. Proton MR spectroscopy in quantitative in vivo determination of fat content in human liver steatosis ［J］. J Magn Reson Imaging, 1995, 5(3): 281-285.
［8］Metha SR, Thomas EL, Patel N, Crofton ME, McCarthy J, Eliahoo J, et al. Proton magnetic resonance spectroscopy and ultrasound for hepatic fat quantification［J］. Hepatol Res, 2010, 40(4): 399-406.
［9］Cowin GJ, Jonsson JR, Bauer JD, Ash S, Ali A, Osland EJ, et al. Magnetic Resonance Imaging and spectroscopy for monitoring liver steatosis［J］. J Magn Reson Imaging, 2008, 28(4): 937-945.
［10］Szczepaniak LS, Nurenberg P, Leonard D, Browning JD, Reingold JS, Grundy S, et al. Magnetic resonance spectroscopy to measure hepatic triglyceride content: prevalence of hepatic steatosis in the general population［J］. Am J Physiol Endocrinol Metab, 2005, 288(2): E462-E468.
［11］Kotronen A, Peltonen M, Hakkarainen A, Sevastianova K,Bergholm R, Johansson LM, et al. Prediction of non-alcoholic fatty liver disease and liver fat using metabolic and genetic factors［J］. Gastroenterology, 2009, 137(3): 865-872.
［12］Larson-Meyer DE, Newcomer BR, VanVrancken-Tompkins CL, Sothern M. Feasibility of assessing liver lipid by proton magnetic resonance spectroscopy in healthy normal and overweight prepubertal children［J］. Diabetes Technol Ther, 2010, 12(3): 207-212.
［13］Zhang H, Peng Y, Liu Z, Li S, Lv Z, Tian L, et al. Effects of acupuncture therapy on abdominal fat and hepatic fat content in obese children: a magnetic resonance imaging and proton magnetic resonance spectroscopy study［J］. J Altern Complement Med, 2011, 17(5): 413-420.
［14］Ma X, Holalkere NS, Kambadakone RA, Mino-Kenudson M, Hahn PF, Sahani DV. Imaging-based quantification of hepatic fat: methods and clinical applications［J］. Radiographics, 2009, 29(5): 1253-1277.
［15］Thomas EL, Hamilton G, Patel N, O′Dwyer R, Doré CJ, Goldin RD, et al. Hepatic triglyceride content and its relation to body adiposity: a magnetic resonance imaging and proton magnetic resonance spectroscopy study［J］. Gut, 2005, 54(1): 122-127.
［16］Cali AM, De Oliveira AM, Kim H, Chen S, ReyesMugica M, Escalera S, et al. Glucose dysregulation and hepatic steatosis in obese adolescents: is there a link?［J］. Hepatology, 2009, 49(6): 1896-1903.
［17］Pacifico L, Nobili V, Anania C, Verdecchia P, Chiesa C. Pediatric nonalcoholic fatty liver disease, metabolic syndrome and cardiovascular risk［J］. World J Gastroenterol, 2011, 17(26): 3082-3091.
［18］Schwimmer JB, Pardee PE, Lavine JE, Blumkin AK, Cook S. Cardiovascular risk factors and the metabolic syndrome in pediatric nonalcoholic fatty liver disease［J］. Circulation, 2008, 118(3): 277-283.
