ESPE2023 Poster Category 1 Fat, Metabolism and Obesity (97 abstracts)
Identifying MAFLD and its metabolic risk factors in Polish children and adolescents with severe obesity. Preliminary results of the Polish-German study project on severe early-onset obesity.
Magdalena Mierzwa 1 , Żaneta Malczyk 2 , Mirosław Bik-Multanowski 3 , Stephanie Brandt 4 , Bertram Flehmig 5 , Ewa Małecka- Tendera 6 , Artur Mazur 7 , Elżbieta Petriczko 8 , Michael B. Ranke 9 , Martin Wabitsch 4 , Małgorzata Wójcik 10 & Agnieszka Zachurzok 2
1Pediatric Endocrinology Ward, Independent Public Clinical Hospital No. 1, Medical University of Silesia in Katowice, Zabrze, Poland. 2Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland. 3Department of Medical Genetics, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland. 4Center for Rare Endocrine Diseases, Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, Ulm, Germany. 5Mediagnost GmbH, Reutlingen, Germany. 6Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland. 7Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical Faculty, University of Rzeszów, Rzeszów, Poland. 8Department of Pediatrics, Endocrinology, Diabetology, Metabolic Disorders and Cardiology of Developmental Age, Pomeranian Medical University, Szczecin, Poland. 9Children’s Hospital, University of Tübingen, Tübingen, Germany. 10Department of Pediatric and Adolescent Endocrinology, Pediatric Institute, Jagiellonian University Medical College, Cracow, Poland
Background: Fatty liver disease in children and adolescents is the most common cause of chronic liver disease in many countries. Criteria for a diagnosis of pediatric metabolic associated fatty liver disease (MAFLD) are based on hepatic steatosis in ultrasound, blood biomarkers or liver biopsy in association with one of the three criteria: excess adiposity (overweight, obesity or abdominal obesity), prediabetes or type 2 diabetes, or evidence of metabolic dysregulation. The study aim is to investigate characteristic features of MAFLD in children and adolescents with severe obesity.
Methods: The study group included 113 individuals with severe obesity (52 males) with the BMI z-score 2.5-9.2 (3.9±0.9aged 1.0-18.8years (13.3±3.1years) enrolled in the Polish-German Study Project on Severe Early-Onset Obesity (SEOO) in four Polish Medical Centers. In all subjects physical examination with anthropometric measurement was performed. Lipids, carbohydrates parameters and liver enzymes were assessed in the fasting state. MAFLD diagnosis was established in all patients with hepatic steatosis detected by the liver ultrasound.
Results: Liver steatosis on US was foundin 65 (57%) children (male 53.8%) and was significantly related to male sex (P=0.009). GGT activity was significantly higher in MAFLD than non-MAFLD group (30.2±19.0 vs. 19.0±7.4μU/ml, P=0.03). Elevated ALT was present in 43 children (66.1%) with MAFLD but the difference between MAFLD and non-MAFLD group did not reach statistical significance (P=0.055). Patients with MAFLD had higher waist circumference than non-MAFLD patients (116.0±12.9 vs. 109.4±15.9cm, P=0.02). Moreover, compared to non-MAFLD group, children with MAFLD showed higher fasting and 120’glucose level in OGTT(90.0±9.7 vs. 84.8±7.8mg/dl, P=0.02; 126.1±30.7 vs. 102.6±32.6mg/dl, P<0.001, respectively), insulin resistance indexes [triglyceride-glucose index (TyG): 8.7±0.5 vs. 8.5±0.4, P=0.008; HOMA-IR: 6.9±4.1 vs. 4.5±3.0, P<0.001)] and lower QUICKI (0.36±0.06 vs. 0.4±0.07, P=0.008). We found positive correlations between the presence of liver steatosis and BMI z-score (P=0.02), waist circumference (P=0.003), fasting and 120’OGTT glucose (P=0.002; P<0.001), fasting and 120’OGTT insulin (P=0.004; P=0.002), HOMA-IR (P<0.001) and TyG (P=0.01) as well as negative correlation with QUICKY (P<0.001) and HDL-cholesterol (P=0.02). There was no correlation between MAFLD and the age of children or obesity duration.
Conclusion: In more than the half of children and adolescents with severe obesity hepatosteatosisis present in abdominal ultrasound. The correlation of MAFLD with abdominal obesity and insulin resistance indexes shows that these factors could be indicators of hepatosteatosis in children and adolescents with severe obesity.
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