Features of using non-invasive tests for assessment of liver fibrosis in obese adolescents

Authors

  • L.K. Parkhomenko Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
  • L.A. Strashok Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
  • M.A. Khomenko Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine http://orcid.org/0000-0002-8412-6393

DOI:

https://doi.org/10.22141/2224-0551.14.0.2019.165523

Keywords:

adolescents, obesity, non-invasive tests for liver fibrosis assessment, non-alcoholic fatty liver disease

Abstract

Background. The prevalence of obesity among children has become a global epidemic today. The importance of this problem is caused by the development of insulin resistance and metabolic syndrome, the hepatic manifestation of which is considered the development of non-alcoholic fatty liver disease (NAFLD), which can lead to the formation of fibrotic changes in the organ already in childhood. The use of non-invasive assessment of liver fibrosis in obese children with NAFLD allows avoid the liver biopsy in some patients, therefore, it is an urgent issue of pediatrics. The purpose of the study was to examine the possibility of using non-invasive tests to assess liver fibrosis in obese adolescents, depending on the presence of insulin resistance. Materials and methods. The study involved 84 adolescents with obesity aged 12–17 years old. A clinical, laboratory and instrumental examination was conducted. For the assessment of liver fibrosis, the following indices were calculated: AST to Platelet Ratio Index (APRI), pediatric NAFLD fibrosis index (PNFI) и Fibrosis-4 (FIB-4). Results. The basic complains among obese adolescents were: increased appetite — 78.6 %, dyspepsia — 54.8 %, abdominal pain — 52.3 %. Depending on the presence of insulin resistance (IR), the patients were divided into two groups: 66.7 % of adolescents with IR and 33.3 % of adolescents without IR. Biochemical analysis of blood in patients with IR revealed significantly higher levels of triglycerides, very low density lipoprotein cholesterol, atherogenic coefficient, HOMA-IR. According to ultrasound examination results, 82.1 % of patients showed signs of NAFLD. When assessing liver fibrosis by calculating PNFI, 35.7 % of patients demonstrated fibrosis signs, and its mean values were significantly higher in patients with IR. There were no patients with signs of significant liver fibrosis on the basis of calculation of FIB-4 and APRI indices, regardless of IR presence. Conclusions. 82.1 % of obese adolescents had signs of NAFLD and 66.7 % were diagnosed with IR. The use of indices for assessing liver fibrosis revealed PNFI to be the most informative one, which showed signs of fibrosis in a one third of obese adolescents.

Downloads

Download data is not yet available.

References

Commission on Ending Childhood Obesity. Facts and Figures on Childhood Obesity. Available from: https://www.who.int/end-childhood-obesity/facts/en/. Accessed: 13 October 2017.

Xu S, Xue Y. Pediatric obesity: causes, symptoms, prevention and treatment. Exp Ther Med. 2016;11(1):15-20. doi:10.3892/etm.2015.2853.

Lobstein T, Jackson-Leach R, Moodie ML, et al. Child and adolescent obesity: part of a bigger picture. Lancet. 2015 Jun 20;385(9986):2510-20. doi: 10.1016/S0140-6736(14)61746-3.

Kumar S, Kelly AS. Review of childhood obesity: from epidemiology, etiology, and comorbidities to clinical assessment and treatment. Mayo Clin Proc. 2017 Feb;92(2):251-265. doi: 10.1016/j.mayocp.2016.09.017.

Conjeevaram Selvakumar PK, Kabbany MN, Alkhouri N. Nonalcoholic fatty liver disease in children: not a small matter. Paediatr Drugs. 2018 Aug;20(4):315-329. doi: 10.1007/s40272-018-0292-2.

Stepanov YuM, Abaturov AYe, Zavgorodnia NYu, Skyrda IYu. Non-Alcoholic Fatty Liver Disease in Children: Current View on Diagnostics and Treatment (Part I). Gastroenterologia. 2015;(56):99-107. (in Ukrainian).

Liyanagedera S, Williams RP, Veraldi S, Nobili V, Mann JP. The pharmacological management of NAFLD in children and adolescents. Expert Rev Clin Pharmacol. 2017 Nov;10(11):1225-1237. doi: 10.1080/17512433.2017.1365599.

Singer C, Stancu P, Coşoveanu S, Botu A. Non-alcoholic Fatty liver disease in children. Curr Health Sci J. 2014 Jul-Sep;40(3):170-6. doi: 10.12865/CHSJ.40.03.03.

Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: зractice пuideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012 Jun;55(6):2005-23. doi: 10.1002/hep.25762.

Nobili V, Alisi A, Vania A, Tiribelli C, Pietrobattista A, Bedogni G. The pediatric NAFLD fibrosis index: a predictor of liver fibrosis in children with non-alcoholic fatty liver disease. BMC Med. 2009 May 1;7:21. doi: 10.1186/1741-7015-7-21.

Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis patients with HIV/HCV co-infection. Hepatology. 2006 Jun;43(6):1317-25. doi: 10.1002/hep.21178.

Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003 Aug;38(2):518-26. doi:10.1053/jhep.2003.50346.

Lin B, Ma Y, Wu S, Liu Y, Liu L, Wu L. Novel serum biomarkers for noninvasive diagnosis and screening of nonalcoholic fatty liver disease-related hepatic fibrosis. OMICS. 2019 Apr;23(4):181-189. doi: 10.1089/omi.2019.0035.

Day JW, Rosenberg WM. The enhanced liver fibrosis (ELF) test in diagnosis and management of liver fibrosis. Br J Hosp Med (Lond). 2018 Dec 2;79(12):694-699. doi: 10.12968/hmed.2018.79.12.694.

Huang Y, Adams LA, Joseph J, Bulsara MK, Jeffrey GP. The ability of Hepascore to predict liver fibrosis in chronic liver disease: a meta-analysis. Liver Int. 2017 Jan;37(1):121-131. doi: 10.1111/liv.13116.

Wu W, Zhang H, Xu X, Huang K, Fu J. Intrahepatic fat content and markers of hepatic fibrosis in obese children. Int J Endocrinol. 2016;2016:4890974. doi: 10.1155/2016/4890974.

Alkhouri N, Carter–Kent C, Lopez R, et al. A combination of the pediatric NAFLD fibrosis index and enhanced liver fibrosis test identifies children with fibrosis. Clin Gastroenterol Hepatol. 2011 Feb;9(2):150-5. doi: 10.1016/j.cgh.2010.09.015.

Rudolph B, Bjorklund N, Ovchinsky N, et al. Methods to improve the noninvasive diagnosis and assessment of disease severity in children with suspected nonalcoholic fatty liver disease (NAFLD): Study design. Contemp Clin Trials. 2018 Dec;75:51-58. doi: 10.1016/j.cct.2018.10.012.

Ooi GJ, Burton PR, Doyle L, et al. Modified thresholds for fibrosis risk scores in nonalcoholic fatty liver disease are necessary in the obese. Obes Surg. 2017 Jan;27(1):115-125. doi: 10.1007/s11695-016-2246-5.

Mansoor S, Yerian L, Kohli R, et al. The evaluation of hepatic fibrosis scores in children with nonalcoholic fatty liver disease. Dig Dis Sci. 2015 May;60(5):1440-7. doi: 10.1007/s10620-014-3494-7.

Published

2021-09-13

How to Cite

Parkhomenko, L., Strashok, L., & Khomenko, M. (2021). Features of using non-invasive tests for assessment of liver fibrosis in obese adolescents. CHILD`S HEALTH, 14, 72–76. https://doi.org/10.22141/2224-0551.14.0.2019.165523

Most read articles by the same author(s)

1 2 > >>