Background/Aims: Pediatric obesity remains an ongoing serious international health concern. Whether liver dysfunction is related to thyroid dysfunction in this population is controversial. Compare SGPT, TSH, FT4 and insulin resistance indexes between children with obesity or severe obesity.
Methods: 279 children (143 females) with ΒΜΙ (≥95percentile) (CDC BMI curves) were divided in two groups (Group 1, obese: 95percentile≤ΒΜΙ<99percentile, Group 2, severe obese: ΒΜΙ≥99percentile) and analyzed retrospectively. Age, sex, tanner stage, BMI in Kg/m2 and percentile (%), SGPT (mg/dl), TSH (mIU/ml) and FT4 (ng/dl) levels were recorded. Insulin resistance was defined as HOMA-IR≥ 3 and Matsuda index ≤2.5. Liver dysfunction as SGPT>22mg/dl for females and >26mg/dl for males and thyroid dysfunction as FT4<1ng/dl. Results: Mean age was 10.5yrs (SD, 2.9), BMI: 30.1Kg/m2(SD,5.3), BMI percentile: 98.8% (SD,0.8), SGPT: 25.3 (SD, 15.6) mg/dl, TSH: 3.3 (SD:1.5) mIU/ml, FT4: 1.2 (SD: 0.2) ng/dl, HOMA-IR:4 (SD,3.5), Matsuda index:3.2 (SD,2). In the whole population, children with insulin resistance presented more frequently liver dysfunction as opposed to non-insulin resistant (76.6 vs 52.7 and 78.4% vs 58.2%, for Matsuda and HOMA-IR respectively, P<0.001). In addition, those with insulin resistance presented more frequently FT4<1ng/dl than those without (87.5% vs. 41.5%, P<0.001 for Matsuda and 87.5% vs 58.6%, p:0.03 for HOMA-IR index). TSH >5mIU/ml was not appreciated more frequently in the insulin resistant children than the non-resistant ones. Finally, in the entire population there was a significant correlation of TSH and FT4 with BMI z-score (r:0.18, p:0.003 and r:-0.14, p:0.04 respectively), however FT4 but not TSH levels correlated significantly with SGPT levels (r:-0.04, p:0.5 and r:-0.18, p:0.01 respectively).
|Group 1 (n=68)||Group 2 (n=211)||p|
|Age (yrs)||10.9 (2.1)||10.3 (3.1)||0.1|
|Sex (males/females)||28/40||108/ 103||0.15|
|BMI (Kg/m2)||26.4 (2.6)||31.3 (5.4)||*|
|BMI (%)||97.6(0.9)||99.2 (0.4)||*|
|SGPT (mg/dl)||25.4 (22.5)||25.3 (12.8)||0.5|
|TSH (mIU/ml)||3.0 (1.2)||3.3 (1.6)||0.1|
|FT4 (ng/dl)||1.2 (0.2)||1.3 (0.2)||0.4|
|HOMA-IR||3.9 (3)||4.1 (3.6)||0.6|
Conclusions: Children with severe obesity (BMI ≥99%) present similar glycemic profile, liver and thyroid function as compared to children with obesity (95%≤ BMI <99%). In euthyroid obese subjects, FT4 seems more closely related than TSH levels to parameters of cardio- metabolic risk. Thus, levothyroxine substitution treatment could be considered in selected patients.
15 Sep 2022 - 17 Sep 2022