ESPE Abstracts (2014) 82 P-D-2-3-387

Enhanced Liver Fibrosis Test in Obese Children with Ultrasound-Proven Steatosis

Krystyna Sztefkob, Patrycja Szybowskab, Malgorzata Wojcika & Jerzy B Starzyka


aDepartment of Pediaric and Adolescent Endocrinology, Medical College, Jagiellonian University, Krakow, Poland; bDepartment of Clinical Biochemistry, Medical College, Jagiellonian University, PAIP, Krakow, Poland


Background: Non-alcoholic fatty liver disease (NAFLD) in obese children is a diagnostic challenge. Presently recommended markers of liver steatosis and risk of progression to fibrosis are: ultrasound imaging (US) and liver aminotransferases (ALT and AST). Owing to the poor sensitivity of these tests, there is a need to search for biomarkers which could indicate early stages of NAFLD. The enhanced liver fibrosis test (ELF) based on the combination of serum concentration of hyaluronic acid (HA), aminoterminal propeptide of type III procollagen (PIIINP), tissue inhibitor of matrix metalloproteinase type 1 (TIMP-1) was developed as a noninvasive diagnostic tool for estimation of degree of liver fibrosis.

Objective and hypotheses: The aim of our study was to investigate the performance of ELF in obese children.

Method: Based on the abdominal US results two groups of obese children were studied: GI (n=22, 8/13 M/F, mean age 14.4±0.41 years) with steatosis and GII (n=40, 20/20 M/F, mean age 13.7±0.46 years) with normal US. HA, PIIINP, and TIMP-1 levels were measured and ELF results were calculated. FIB4 score was calculated based on platelets counts, age, AST and ALT according to formula: age×AST/PLT×(ALT)1/2. Standard oral glucose tolerance test with the assessment of glucose and insulin level was performed.

Results: The ELF were higher in GI (9.0±0.15 vs 8.48±0.09, P<0.005). The mean values of HA, PIIINP, TIMP1, and FIB4 score were also higher in GI, significantly for HA (19.6±2.73 vs 12.0±0.95) and TIMP-1 (251.1±8.44 vs 220.0±6.15, P<0.005). There was a correlation between ELF and insulin level 120′ after glucose load (R=0.4, P<0.05), but no correlation with fasting insulin or glucose level, HOMA nor Matsuda indices, aminotransferases, FIB4, age, and BMI.

Conclusion: ELF test cannot be used as a single biochemical component for assessing of NAFLD, but can be useful as its predictor. To assess its relationship with insulin resistance parameters further investigations are needed.

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