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India-Aldana S, Midya V, Betanzos-Robledo L, Yao M, Alcalá C, Andra SS, Arora M, Calafat AM, Chu J, Deierlein A, Estrada-Gutierrez G, Jagani R, Just AC, Kloog I, Landero J, Oulhote Y, Walker RW, Yelamanchili S, Baccarelli AA, Wright RO, Téllez Rojo MM, Colicino E, Cantoral A, Valvi D. Metabolism-Disrupting Chemical Mixtures during Pregnancy, Folic Acid Supplementation, and Liver Injury in Mother-Child Pairs. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.13.24308903. [PMID: 38947077 PMCID: PMC11213105 DOI: 10.1101/2024.06.13.24308903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Background and Aims Scarce knowledge about the impact of metabolism-disrupting chemicals (MDCs) on liver injury limits opportunities for intervention. We evaluated pregnancy MDC-mixture associations with liver injury and effect modification by folic acid (FA) supplementation in mother-child pairs. Methods We studied ∼200 mother-child pairs from the Mexican PROGRESS cohort, with measured 43 MDCs during pregnancy (estimated air pollutants, blood/urine metals or metalloids, urine high- and low-molecular-weight phthalate [HMWPs, LMWPs] and organophosphate-pesticide [OP] metabolites), and serum liver enzymes (ALT, AST) at ∼9 years post-parturition. We defined liver injury as elevated liver enzymes in children, and using established clinical scores for steatosis and fibrosis in mothers (i.e., AST:ALT, FLI, HSI, FIB-4). Bayesian Weighted Quantile Sum regression assessed MDC-mixture associations with liver injury outcomes. We further examined chemical-chemical interactions and effect modification by self-reported FA supplementation. Results In children, many MDC-mixtures were associated with liver injury outcomes. Per quartile HMWP-mixture increase, ALT increased by 10.1% (95%CI: 1.67%, 19.4%) and AST by 5.27% (95% CI: 0.80%, 10.1%). LMWP-mixtures and air pollutant-mixtures were associated with higher AST and ALT, respectively. Air pollutant and non-essential metal/element associations with liver enzymes were attenuated by maternal cobalt blood concentrations ( p -interactions<0.05). In mothers, only the LMWP-mixture was associated with liver injury [OR=1.53 (95%CI: 1.01, 2.28) for HSI>36, and OR=1.62 (95%CI: 1.05, 2.49) for AST:ALT<1]. In mothers and children, most associations were attenuated (null) at FA supplementation≥600mcg/day ( p -interactions<0.05). Conclusions Pregnancy MDC exposures may increase liver injury risk, particularly in children. These associations may be attenuated by higher FA supplementation and maternal cobalt levels.
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Ferretti RDL, Maia-Lemos PDS, Guedes KJT, Caran EMM. Neck Circumference for Identification of Excess Adiposity in Adolescents with Cancer: A Better Parameter for Use in Clinical Practice? J Adolesc Young Adult Oncol 2024; 13:316-322. [PMID: 37878304 DOI: 10.1089/jayao.2022.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Purpose: Excess weight in adolescents with cancer during treatment does affect cancer outcomes. Neck circumference (NC), an easygoing anthropometric measure, may present greater metabolic risk, and is associated with excess adiposity. The aim of this study was to identify the prevalence of elevated NC in adolescents with cancer and associated factors. Methods: Cross-sectional study with adolescents aged 10-19 years, under antineoplastic treatment, evaluated from 2015 to 2017, at a Pediatric Oncology Institute's outpatient clinic. Anthropometric parameters were collected, besides diagnosis, sex, and age. The classification of elevated NC was carried out considering cutoff values for adolescents, according to sex and age group. A binary logistic regression was used to determine relationships between NC and associated factors. Results: Among 496 eligible cases, most were male (n = 299, 60.3%). A total of 31.9% of cases had high NC. There is significant and moderate correlation between skinfold thickness (TS) and NC (ρ = 0.6; p = 0.000), and a significant but weak correlation between TS and body mass index (ρ = 0.267; p = 0.000). The adjusted analysis for sex, age group, and type of tumor showed that females are more likely to belong to the high NC category, to have excess adiposity. The age group between 10 and 12 years was the most associated with this outcome (2.795 [0.979-7.977]; p < 0.05). TS is also associated with high NC (1.114 [1.050-1.182]; p < 0.05). Conclusion: It was concluded that there is high prevalence of elevated NC and higher risks for this outcome considering type of tumor, sex, age group, besides being an easy and simple measure for use in clinical practice.
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Affiliation(s)
- Roberta de Lucena Ferretti
- Department of Pediatrics, Support Group for Children and Adolescents with Cancer (GRAACC), Federal University of Sao Paulo, Sao Paulo, Brazil
- Department of Nursing and Nutrition, University of Taubate, Taubate, Brazil
| | - Priscila Dos Santos Maia-Lemos
- Department of Pediatrics, Support Group for Children and Adolescents with Cancer (GRAACC), Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Karen Jaloretto Teixeira Guedes
- Department of Pediatrics, Support Group for Children and Adolescents with Cancer (GRAACC), Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Eliana Maria Monteiro Caran
- Department of Pediatrics, Support Group for Children and Adolescents with Cancer (GRAACC), Federal University of Sao Paulo, Sao Paulo, Brazil
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Stankute I, Dulskiene V, Kuciene R. Associations between Neck Circumference, Mid-Upper Arm Circumference, Wrist Circumference, and High Blood Pressure among Lithuanian Children and Adolescents: A Cross-Sectional Study. Nutrients 2024; 16:677. [PMID: 38474805 DOI: 10.3390/nu16050677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
(1) Background: High blood pressure (HBP) and obesity are significant and growing public health issues worldwide. Our study aimed to evaluate the associations of neck circumference (NC), mid-upper arm circumference (MUAC), and wrist circumference (WrC) with HBP among Lithuanian children and adolescents aged 7-17 years. (2) Methods: In this cross-sectional study, data on BP and anthropometric measurements were analysed in 3688 children and adolescents aged 7-17 years. Multivariate logistic regression analysis was used to estimate the associations between anthropometric indices and HBP. (3) Results: Overall, the prevalence rates of elevated BP and hypertension were 13.7% and 12.9%, respectively. After adjustment for age, BMI, and WC, statistically significant elevated aORs were observed for associations between greater NC, MUAC, WrC, and HBP in boys (aORs: 2.13, 2.46, and 2.48, respectively) and in girls (aORs: 2.01, 2.36, and 2.09, respectively). Moreover, per-unit increase in NC, MUAC, and WrC was also associated with greater odds of HBP in boys (aORs: 1.20, 1.21, and 1.37, respectively) and in girls (aORs: 1.10, 1.10, and 1.21, respectively). The analysed anthropometric indices presented higher area under the curve values for predicting HBP in boys than in girls. (4) Conclusions: This study suggests that higher NC, MUAC, and WrC are associated with increased odds of HBP in Lithuanian children and adolescents.
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Affiliation(s)
- Ieva Stankute
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukileliu 15, LT-50162 Kaunas, Lithuania
| | - Virginija Dulskiene
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukileliu 15, LT-50162 Kaunas, Lithuania
| | - Renata Kuciene
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukileliu 15, LT-50162 Kaunas, Lithuania
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Martínez-Triana MA, Zavala-Rodríguez M, Villaseñor-López K, Martínez-Tovilla Y, Peña-Vélez R. Knowledge of the recommendations for the diagnosis and treatment of childhood obesity among a group of medical students in Mexico. NUTR HOSP 2024; 41:266-269. [PMID: 38047413 DOI: 10.20960/nh.04921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Introduction
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Affiliation(s)
| | | | | | | | - Rubén Peña-Vélez
- Division of Pediatric Gastroenterology, Hepatology and Nutrition. Hospital General de Puebla Dr. Eduardo Vázquez Navarro
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Zeng J, Jin Q, Yang J, Yang RX, Zhang RN, Zhao J, Fan JG. Prevalence and incidence of MAFLD and associated anthropometric parameters among prepubertal children of the Shanghai Birth Cohort. Hepatol Int 2023; 17:1416-1428. [PMID: 37728728 DOI: 10.1007/s12072-023-10574-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/21/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND AND AIM Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common chronic liver disease in adolescent and adult population. However, the epidemiologic data of MAFLD in prepubertal children remain limited. This study aimed to investigate the prevalence and incidence of MAFLD and assess the role of anthropometric parameters in identifying and predicting MAFLD in this population. METHODS Children from the Shanghai Birth Cohort Study who underwent an 8-year follow-up with anthropometric measurements and transient elastography FibroScan-502 examination (M probe, Echosens, Paris, France) were enrolled. Some of them also completed a 5-year follow-up. Diagnosis of fatty liver disease (FLD) was based on the controlled attenuation parameter (CAP) value exceeding 248 dB/m, and MAFLD was defined as FLD combined with obesity or central obesity. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the diagnostic accuracy of anthropometric parameters for MAFLD. RESULTS A total of 848 children (431 boys) from the Shanghai Birth Cohort Study were followed up for 8 years, and among them, 385 children (189 boys) also participated in the 5-year follow-up. The prevalence of FLD and MAFLD at 5 years old was 3.90% and 0.52%, respectively, while at 8 years old, the prevalence rates increased to 5.07% for FLD and 3.42% for MAFLD. The 8-year-old children with MAFLD exhibited significantly higher weight, body mass index (BMI), chest circumference, waist circumference, hip circumference, waist-to-height ratio, waist-to-hip ratio, and liver stiffness measurement compared to those without MAFLD (all p < 0.05). The incidence rates of FLD and MAFLD at 8 years old, considering the 5-year follow-up data, were 3.78% (14/370) and 3.13% (12/383), respectively. Obese or centrally obese children at 5 years old had a higher incidence of FLD and MAFLD at the 8-year follow-up. Waist circumference and BMI showed significant associations with the presence and incidence of MAFLD, respectively, with the largest AUC values in ROC curve analysis. In addition, chest circumference was significantly associated with MAFLD in obese children. CONCLUSION This study provides insights into the incidence and prevalence of MAFLD in prepubertal children. It underscores the importance of anthropometric parameters in identifying and predicting MAFLD in this population. Further research encompassing a broader age range and incorporating these indicators and additional metabolic markers is necessary to enhance the understanding and management of MAFLD in children.
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Affiliation(s)
- Jing Zeng
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Qian Jin
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Jing Yang
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Rui-Xu Yang
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Rui-Nan Zhang
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Jian Zhao
- The Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China.
- Department of Maternal and Child Health, School of Public Health, Shanghai Jiao Tong University, Shanghai, China.
| | - Jian-Gao Fan
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China.
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Zhou L, Zhang L, Zhang L, Yi W, Yu X, Mei H, Xiao H, Wang Y, Qin H, Xiong X, Yan S, Dong H, Chen P, Chen X. Analysis of risk factors for non-alcoholic fatty liver disease in hospitalized children with obesity before the late puberty stage. Front Endocrinol (Lausanne) 2023; 14:1224816. [PMID: 37720532 PMCID: PMC10501779 DOI: 10.3389/fendo.2023.1224816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/04/2023] [Indexed: 09/19/2023] Open
Abstract
Objective This study aimed to determine the clinical characteristics of obese pediatric non-alcoholic fatty liver disease (NAFLD) in central China and verify the applicability of some known risk factors for pediatric NAFLD before late puberty. Methods This was a retrospective case-control study. A total of 1,029 inpatients at Wuhan Children's Hospital before the late puberty stage were enrolled in the study, including 815 children with obesity (non-NAFLD group) and 214 children with obesity and NAFLD (NAFLD group) diagnosed by liver ultrasound. Subgroup analyses were performed according to sex and puberty. The anthropometric indices and laboratory test data of these 1,029 children were sorted. After intergroup comparison, a logistic regression model was used to determine the risk factors for pediatric NAFLD. Significant risk factors for NAFLD were further tested using receiver operating characteristic (ROC) curves to evaluate their ability to predict an early diagnosis of NAFLD. Results The NAFLD group had a mean age of 11.03 ± 1.66, with 11.18 ± 1.66 and 10.27 ± 1.45 years for male and female children, respectively (p < 0.05 and p < 0.01, respectively). Even subdivided by both sex and puberty, raised body mass index (BMI), homeostatic model-insulin resistance, triglycerides, alanine transaminase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (γ-GT) were still found in the non-NAFLD and NAFLD groups (p < 0.05 and p < 0.01, respectively). The results of logistic regression analysis showed that BMI (odds ratio [OR], 1.468;95% confidence interval [CI], 1.356-1.590; p<0.001) and ALT (OR, 1.073;95%CI, 1.060-1.087; P<0.001) were two most independent risk factors for NAFLD. The maximal OR for BMI was 1.721 (95% CI, 1.336-2.217). In the female group, the maximal OR of ALT was found to be 1.104 (95% CI, 1.061-1.148). Age and thyroid-stimulating hormone (TSH) and γ-GT levels were also risk factors, but they appeared only in some groups. The results of the ROC analysis showed that ALT was a better predictor of pediatric NAFLD than BMI. The maximum area under the ROC curve in six of the nine groups belongs to ALT. Conclusions BMI, ALT, and age are risk factors for NAFLD in children with obesity before late puberty. BMI had the greatest exposure risk for NAFLD, and ALT had the highest predictive value for the diagnosis of NAFLD. At the stratified level, for exposure risk, age was specific to the male sex, TSH was specific to the early puberty stage, and γ-GT was specific to the female sex plus the prepuberty stage. On a stratified level, for the female sex, even with age stratification, BMI rather than ALT has a better ability for the diagnosis of NAFLD.
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Affiliation(s)
- Lishan Zhou
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Linli Zhang
- Wuhan Wuchang Hospital, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Lingling Zhang
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wei Yi
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xue Yu
- Department of Pediatrics, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Affiliated Hospital of Jianghan University, Jianghan University, Wuhan, Hubei, China
| | - Hong Mei
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Haiyan Xiao
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuji Wang
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huan Qin
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoli Xiong
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Suqi Yan
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hui Dong
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Peng Chen
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaohong Chen
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Avelar-Rodríguez D, Peña-Vélez R, Popov J, Hill L, Ryan PM. Probiotics and non-alcoholic fatty liver disease in children and adolescents: a systematic review. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:418-427. [PMID: 36412490 DOI: 10.17235/reed.2022.8796/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND non-alcoholic fatty liver disease (NAFLD) in childhood is an increasing global public health issue with significant long-term consequences. NAFLD management mainly consists of lifestyle modifications, however, adjunct pharmacological therapies are currently lacking. Gut microbiota manipulation via probiotics may alter the course of pediatric NAFLD. The objective of this systematic review was to synthesize all the available literature on the use of probiotics in children and adolescents with NAFLD. METHODS PubMed, EBSCOhost, Scopus, Web of Science, and Cochrane Library were systematically searched for trials on the use of probiotics in pediatric NAFLD. A quantitative DerSimonian Laird random effects meta-analysis was performed when possible; otherwise, a narrative summary of the study outcomes was presented and discussed. A separate search was completed to include all the ongoing registered trials on probiotics use in pediatric NAFLD. RESULTS five randomized controlled trials met the inclusion criteria. Of these, four trials were included in the final quantitative analysis. Probiotic therapy significantly reduced the levels of alanine aminotransferase (ALT) (mean difference: -10.39 [-19.85, -0.93]), however significant heterogeneity between studies was identified (I2, 93 %). CONCLUSIONS there is insufficient evidence to support probiotics in the treatment of pediatric NAFLD given the substantial degree of discordance amongst the available trials. Lifestyle modifications focusing on maintaining a normal BMI and regular exercise continue to be the gold standard approach to treating NAFLD in children.
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Affiliation(s)
| | - Rubén Peña-Vélez
- Gastroenterología y Nutrición, Hospital General de Puebla "Dr. Eduardo Vázquez N", México
| | - Jelena Popov
- College of Medicine and Health. University College Cork
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Liu H, Li X, Han X, Zhang Y, Gu Y, Sun L, Han J, Tu Y, Bao Y, Bai W, Yu H. Simple surrogate equations to predict controlled attenuation parameter values for screening non-alcoholic fatty liver disease in a Chinese population. Front Med (Lausanne) 2022; 9:894895. [PMID: 35935792 PMCID: PMC9355088 DOI: 10.3389/fmed.2022.894895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveNon-alcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease. The controlled attenuation parameter (CAP) obtained by FibroScan reflects the level of liver steatosis in patients with obesity. Our study aimed to construct a simple equation to predict the CAP, to facilitate the screening and monitoring of patients at high risk for NAFLD.MethodsA total of 272 subjects were randomly divided into derivation and validation cohorts at a ratio of 1:2. The derivation set was used for constructing a multiple linear regression model; the validation set was used to verify the validity of the model.ResultsSeveral variables strongly correlated with the CAP were used to construct the following equation for predicting CAP values:CAP1 = 2.4 × BMI + 10.5 × TG+ 3.6 × NC + 10.3 × CP +31.0, where BMI is body mass index, TG is triglyceride, NC is neck circumference and CP is C-peptide. The CAP1 model had an R2 of 0.764 and adjusted R2 of 0.753. It was then simplified to derive CAP2 included only simple anthropometric parameters: CAP2 = 3.5 × BMI + 4.2 × NC + 20.3 (R2 = 0.696, adjusted R2 = 0.689). The data were well fitted by both models. In the verification group, the predicted (CAP1 and CAP2) values were compared to the actual CAP values. For the CAP1 equation, R2 = 0.653, adjusted R2 = 0.651. For the CAP2 equation, R2 = 0.625, adjusted R2 = 0.623. The intra-class correlation coefficient (ICC) values were 0.781 for CAP1 and 0.716 for CAP2 (p < 0.001). The actual CAP and the predicted CAP also showed good agreement in Bland-Altman plot.ConclusionThe equations for predicting the CAP value comprise easily accessible variables, and showed good stability and predictive power. Thus, they can be used as simple surrogate tools for early screening and follow-up of NAFLD in the Chinese population.
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Affiliation(s)
- Hanying Liu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Xiao Li
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Xiaodong Han
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yan Zhang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Yanting Gu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Lianjie Sun
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Junfeng Han
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Yinfang Tu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Wenkun Bai
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
- *Correspondence: Wenkun Bai,
| | - Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
- Haoyong Yu,
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Quek SXZ, Tan EXX, Ren YP, Muthiah M, Loo EXL, Tham EH, Siah KTH. Factors early in life associated with hepatic steatosis. World J Hepatol 2022; 14:1235-1247. [PMID: 35978672 PMCID: PMC9258263 DOI: 10.4254/wjh.v14.i6.1235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/01/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The rise in prevalence of non-alcoholic fatty liver disease (NAFLD) mirrors the obesity epidemic. NAFLD is insidious but may gradually progress from simple steatosis to steatohepatitis, fibrosis and cirrhosis and/or hepatocellular carcinoma. Intervention strategies to ameliorate developmental programming of NAFLD may be more efficacious during critical windows of developmental plasticity.
AIM To review the early developmental factors associated with NAFLD.
METHODS Databases MEDLINE via PubMed, and EMBASE and Reference Citation Analysis were searched and relevant publications up to April 30, 2021 were assessed. Original research studies that included risk factors associated with early development of NAFLD in human subjects were included. These factors include: Maternal factors, intrauterine and prenatal factors, post-natal factors, genetic and ethnic predisposition, childhood and adolescence environmental factors. Studies were excluded if they were review articles or animal studies, case reports or conference abstracts, or if NAFLD was not clearly defined and assessed radiologically.
RESULTS Of 1530 citations identified by electronic search, 420 duplicates were removed. Of the 1110 citations screened from title and abstract, 80 articles were included in the final analysis. Genetic polymorphisms such as patatin-like phospholipase domain-containing protein 3 (PNPLA3) and membrane-bound O-acyltransferase domain-containing protein 7 (MBOAT7) were associated with increased risk of NAFLD. Familial factors such as maternal obesogenic environment and parental history of hepatic steatosis was associated with offspring NAFLD. Longer duration of exclusive breastfeeding in infancy was associated with a lower risk of developing NAFLD later in life while metabolic dysfunction and/or obesity in adolescence was associated with increased risk of NAFLD. Studies relating to socioeconomic factors and its association with NAFLD reported confounding results.
CONCLUSION Maternal metabolic dysfunction during pregnancy, being exclusively breastfed for a longer time postnatally, diet and physical activity in childhood and adolescence are potential areas of intervention to decrease risk of NAFLD.
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Affiliation(s)
- Sabrina Xin Zi Quek
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Eunice Xiang-Xuan Tan
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Yi Ping Ren
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Mark Muthiah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Evelyn Xiu Ling Loo
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore 119228, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore
| | - Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore 119228, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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10
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Fojas EGF, Buckley AJ, Lessan N. Associations between neck circumference and markers of dysglycemia, non-alcoholic fatty liver disease, and dysmetabolism independent of Body Mass Index in an Emirati population. Front Endocrinol (Lausanne) 2022; 13:929724. [PMID: 36147574 PMCID: PMC9485482 DOI: 10.3389/fendo.2022.929724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
AIM Neck circumference (NC) is quick and easy to measure and may be a useful surrogate marker for body composition. We investigated NC as a potential marker of dysglycemia, MetS, and NAFLD. METHODS 674 individuals were recruited at the Imperial College London Diabetes Centre in a study of sleep apnea prevalence. Of these, 547 (Age 46 ± 11.4 years, Body Mass Index (BMI) 31 ± 6 kg/m2, 279 (51%) female, 113 normal glucose tolerance (NGT), 108 Prediabetes, 326 Type 2 diabetes (T2DM)) met all inclusion criteria for analysis. NC was measured at the thyroid cartilage, and collar size was recorded. Analysis was performed using univariate and multivariate linear regression. RESULTS Adjusted for BMI, sex, and age, NC was 0.65 ± 0.3 cm greater in prediabetes (p = 0.0331), and 1.07 ± 0.28 cm greater in T2DM, compared with NGT (p = 0.0002). Adjusting for BMI, sex, and glycemic status, 1-cm increase in NC was associated with a 1.04 ± 1.01 U/L (p <0.0001) increase in ALT and, additionally, correcting for statin use, a 0.03 ± 0.01 mmol/L reduction in HDL (p <0.0001) and a 0.1 ± 0.02 increase in TC : HDL. A 1 cm increase in NC was associated with a 1.15 ± 1.02% (p <0.0001) increase in 10-year AHA cardiovascular risk in individuals over 40 years old and a 0.16 ± 0.02 (p <0.0001) increase in NAFLD fibrosis score. The neck circumference was associated with the hazard of new onset of deranged ALT adjusted for age, sex, glycemic status, and BMI (hazard ratio 1.076 (95% CI 1.015-1.14, p = 0.0131) and with the incidence of Fatty Liver Index associated with high probability of NAFLD (hazard ratio 1.153 (95% CI 1.019-1.304), p = 0.0239). CONCLUSION NC is associated with dysglycemia, components of the MetS, and factors predictive of NAFLD, but does not appear to independently predict subsequent progression to high risk of liver fibrosis in this predominantly diabetic population.
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11
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Eslam M, Alkhouri N, Vajro P, Baumann U, Weiss R, Socha P, Marcus C, Lee WS, Kelly D, Porta G, El-Guindi MA, Alisi A, Mann JP, Mouane N, Baur LA, Dhawan A, George J. Defining paediatric metabolic (dysfunction)-associated fatty liver disease: an international expert consensus statement. Lancet Gastroenterol Hepatol 2021; 6:864-873. [PMID: 34364544 DOI: 10.1016/s2468-1253(21)00183-7] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/11/2022]
Abstract
The term non-alcoholic fatty liver disease (NAFLD), and its definition, have limitations for both adults and children. The definition is most problematic for children, for whom alcohol consumption is usually not a concern. This problematic definition has prompted a consensus to rename and redefine adult NAFLD associated with metabolic dysregulation to metabolic (dysfunction)-associated fatty liver disease (MAFLD). Similarities, distinctions, and differences exist in the causes, natural history, and prognosis of fatty liver diseases in children compared with adults. In this Viewpoint we, an international panel, propose an overarching framework for paediatric fatty liver diseases and an age-appropriate MAFLD definition based on sex and age percentiles. The framework recognises the possibility of other coexisting systemic fatty liver diseases in children. The new MAFLD diagnostic criteria provide paediatricians with a conceptual scaffold for disease diagnosis, risk stratification, and improved clinical and multidisciplinary care, and they align with a definition that is valid across the lifespan.
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Affiliation(s)
- Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, Australia.
| | - Naim Alkhouri
- Department of Hepatology, Arizona Liver Health, Chandler, AZ, USA
| | - Pietro Vajro
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy
| | - Ulrich Baumann
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Ram Weiss
- Department of Pediatrics, Ruth Rappaport Children's Hospital, Rambam Medical Center, Technion School of Medicine, Haifa, Israel
| | - Piotr Socha
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Paediatrics, Children's Memorial Health Institute, Warsaw, Poland
| | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Way Seah Lee
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Deirdre Kelly
- The Liver Unit, Birmingham Women's & Children's Hospital, University of Birmingham, Birmingham, UK
| | - Gilda Porta
- Pediatric Hepatology, Transplant Unit, Hospital Sírio-Libanês, Hospital Municipal Infantil Menino Jesus, San Paulo, Brazil
| | - Mohamed A El-Guindi
- Department of Pediatric Hepatology, Gastroenterology and Nutrition, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Anna Alisi
- Research Unit of Molecular Genetics and Complex Phenotypes, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Jake P Mann
- Metabolic Research Laboratories, Institute of Metabolic Science, and Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Nezha Mouane
- Department of Pediatric Hepatology, Gastroenterology and Nutrition, Academic Children's Hospital, Mohammed V University, Rabat, Morocco; Department of Pediatric Hepatology, Gastroenterology and Nutrition, Children's Hospital of Rabat, Rabat, Morocco
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Anil Dhawan
- Paediatric Liver, GI and Nutrition Centre, and MowatLabs, King's College Hospital, London, UK
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
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12
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Valencia-Sosa E, González-Pérez GJ, Martinez-Lopez E, Rodriguez-Echevarria R. Neck and Wrist Circumferences as Indicators of Metabolic Alterations in the Pediatric Population: A Scoping Review. CHILDREN-BASEL 2021; 8:children8040297. [PMID: 33924538 PMCID: PMC8070358 DOI: 10.3390/children8040297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/05/2021] [Accepted: 04/10/2021] [Indexed: 12/27/2022]
Abstract
Neck circumference (NC) and wrist circumference (WrC) have been proposed as practical and inexpensive tools with the capacity to indicate metabolic alterations to some extent. Nevertheless, their application in the pediatric population is relatively recent. Thus, the aim of this scoping review was to review and analyze the reported evidence regarding the correlation of NC and WrC with metabolic alterations in the pediatric stage. The literature search was performed in January 2021 in seven indexes and databases. A total of 26 articles published between 2011 and 2020 were included. Most significant results were grouped into three categories: serum lipid profile, glucose homeostasis, and blood pressure. The parameter that showed the most significant results regardless of the anthropometric indicator analyzed for association was blood pressure. In contrast, total cholesterol and LDL-cholesterol showed non-significant associations along with conflicting results. We conclude that the use of NC and WrC, in addition to other well-established indicators, could facilitate the identification of metabolic alterations, specifically in plasma insulin and blood pressure. In fact, further studies are required to address the potential use of NC and WrC as predictors of early metabolic alterations, especially in countries with a fast-growing prevalence in obesity.
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Affiliation(s)
- Evelyn Valencia-Sosa
- Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Sierra Mojada 950, Guadalajara, Jalisco 44340, Mexico; (E.V.-S.); (G.J.G.-P.)
| | - Guillermo Julián González-Pérez
- Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Sierra Mojada 950, Guadalajara, Jalisco 44340, Mexico; (E.V.-S.); (G.J.G.-P.)
| | - Erika Martinez-Lopez
- Instituto de Nutrigenética y Nutrigenómica Traslacional, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Sierra Mojada 950, Guadalajara, Jalisco 44340, Mexico;
| | - Roberto Rodriguez-Echevarria
- Instituto de Nutrigenética y Nutrigenómica Traslacional, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Sierra Mojada 950, Guadalajara, Jalisco 44340, Mexico;
- Correspondence: ; Tel.: +52-33-1058-5200
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