ESPE2023 Poster Category 1 Fat, Metabolism and Obesity (97 abstracts)
Exploring the Relationship between Muscle-to-Fat Ratio and Surrogate Markers of Nonalcoholic Fatty Liver Disease in Children with Overweight and Obesity
Adi Uretzky 1,2 , Hussein Zaitoon 1,2 , Asaf Ben Simon 2 , Eyal Cohen-Sela 2 , Michal Yackobovitch-Gavan 3 , Eyas Midlij 1 , Ophir Borger 1,4 , Hagar Interator 1,4 , Achiya Amir 5,6 , Hadar Moran-Lev 5,6 , Avivit Brener 1,5 & Yael Lebenthal 1,5
1The Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv, Israel. 2Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 3Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 4The Nutrition and Dietetics Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 5Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 6The Pediatric Gastroenterology Unit, Dana Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Tel Aviv, Israel
Background: We previously reported on the strong predictive value of the muscle-to-fat ratio (MFR) z-score in the development of early-onset metabolic syndrome components in children with overweight/obesity. Data on the role of the balance between muscle and fat in the development of childhood onset nonalcoholic fatty liver disease (NAFLD) are sparse. In the current study we explored the interplay between MFR and surrogate markers of NAFLD in children with overweight/obesity.
Methods: An observational study of 136 pediatric subjects (56 boys, mean age 12.7±3.4 years, median BMI z-score 2.03 [range: 1.04-4.04]) from March 2022 to March 2023. Body composition was measured by bioelectrical impedance analysis (BIA, Tanita MC-780 MA and GMON Professional Software), and MFR z-scores were calculated. Outcome measures included: aspartate aminotransferase (AST)/alanine transaminase (ALT) ratio, AST to platelet ratio index (APRI), Fibrosis-4 index, NAFLD score, and steatosis (abdominal ultrasonography). Ultrasonography was performed in 62 out of 110 children with obesity (BMI z-score > 1.645).
Results: Strong negative correlations were found between the MFR z-score and the BMI z-score (r= -0.708, P<0.001) and fat percentage (r= -0.675, P<0.001). The MFR z-score showed a positive correlation with AST/ALT ratio (r= 0.35, P<0.001), and a negative correlation with ALT (r= -0.294, P<0.001), HOMA-IR (r= -0.26, P=0.022) and age (r= -0.196, P= 0.023). No significant correlations were found between the MFR z-score and APRI, Fibrosis-4 index, and NAFLD score. Among the children who performed ultrasonography, 72.5% (n=45/62) showed evidence of steatosis. These children were older (14.1±2.9 vs. 12.1±2.8 years, P=0.019) and had significant differences in AST/ALT ratio (0.82 [IQR 0.66, 1.18] vs. 1.13 [IQR 1, 1.25], P=0.006), APRI (0.23 [IQR 0.16, 0.32] vs. 0.16 [IQR 0.15, 0.19, P=0.025), Fibrosis-4 index (0.23 [IQR 0.16, 0.30] vs. 0.18 [IQR 0.15, 0.19, P=0.026) and HOMA-IR (6 [IQR 3.8, 8.8] vs. 3.8 [IQR 2.25, 5.75], P=0.05) as compared to those without evidence of steatosis. In a logistic regression model, the only variable that showed a negative association with steatosis was the AST/ALT ratio (Or= 0.011 [95%CI 0.001, 0.284], P<0.001).
Conclusions: This study highlights the potential role of an unfavorable body composition in the development of NAFLD in children with overweight or obesity. Preventive strategies should apply interventions for improving not only weight status but also the body composition parameters of both adiposity and muscle. However, further research is needed to determine the clinical significance of MFR in the development of NAFLD in children.
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