ESPE2024 Poster Category 2 Fat, Metabolism and Obesity (39 abstracts)
Prevalence and risk factors of Metabolic Associated Fatty Liver Disease (MAFLD) in polish children and adolescents with severe obesity.
Ewa Kostrzeba 1 , Mirosław Bik-Multanowski 2,3 , Stephanie Brandt 4 , Bertram Flehmig 5 , Ewa Małecka-Tendera 6 , Artur Mazur 7 , Michael B. Ranke 8 , Martin Wabitsch 4 , Małgorzata Wójcik 9 , Agnieszka Zachurzok 10 & Elżbieta Petriczko 1
1Department of Pediatrics, Endocrinology, Diabetology, Metabolic Disorders and Cardiology of Developmental Age, Pomeranian Medical University, Szczecin, Poland. 2Department of Medical Genetics, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland. 3University Hospital, LMU Munich, Institute of Human Genetics, Munich, Germany. 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. 8Children’s Hospital, University of Tübingen, Tübingen, Germany. 9Department of Pediatric and Adolescent Endocrinology, Pediatric Institute, Jagiellonian University Medical, Cracow, Poland. 10Pediatric Endocrinology Ward, Independent Public Clinical Hospital No. 1, Medical University of Silesia in Katowice, Zabrze, Poland
Aims: The aimof this study was to investigate the prevalence and risk factors of MAFLD in severely obese polish children and adolescents.
Patients and Methods: Data were collected in four Polish medical centers as a part of the project "Prevalence of monogenic obesity among Polish children and adolescents with severe obesity" (funded by National Science Center, Poland (2021/41/B/NZ5/01676)). Inclusion criteria for the study was BMI>25 kg/m2 below the age 2, BMI>30 for ages 2-6 years, BMI>35 for ages 6-14 years and BMI>40 in children above 14 years. Each patient had measured weight, height, waist and hip circumference, blood pressure, up taken blood sample to determine lipid profile, ALT, AST, fasting glucose and insulin. Information about age and BMI of the parents was also collected.
Results: The study group consisted of 367 children: 181 girls (49%), 186 boys (51%), 40 prepubertal children (11%), 327 pubertal children (89%), aged 2.2 - 18.0 (mean: 13.6/SD: 2.9), with BMI Z-score 2.3-6.2 (2.7/0.4), WHR 0.5-4.5 (0.9/0.2), WHtR 0.3-1.0 (0.7/0.1), HOMA IR 1.2-30.3 (6.8/3.8). 252/367 children underwent abdominal ultrasound. 158/252 children (63.7%) met the criteria of MAFLD, based on obesity and liver steatosis identified by imaging studies. Within this group 142 (90%) were pubertal children, 16 (10%) were prepubertal with mean age 13.8 years. The values of each examined parameters were classified into one of two groups based on their medians as a cut-off points. In order to determine the presence of significant relationship – univariable logistic models were used. The occurrence of MAFLD was significantly increased for patients with SBP≥136 mm/Hg (OR=1.77;95% CI=1.04–3.04; P =0.036), glucose at 120' of OGTT≥114 mg/dl (OR=1.95;95% CI=1.11-3.45; P =0.021), insulin at 120' of OGTT≥113.12 µIU/ml (OR=3.04;95% CI=1.68-5.62; P <0.001), TGD≥119 mg/dl (OR=2.82;95% CI =1.64-4.94; P <0.001), ALT≥29 U/l (OR=2.46;95% CI=1.44–4.25; P <0.001), AST≥25 U/l (OR=1.82;95% CI=1.06-3.14; P =0.03) and HOMA IR≥5.84 (OR=1.78;95% CI=1.03-3.08; P =0.039). No significant association between BMI, BMI and age of the parents, DBP, fasting glucose, fasting insulin, total cholesterol, LDL, HDL, WHR and WHtR was found.
Conclusion: More than half of the examined children and adolescents was diagnosed with MAFLD - with 10% being prepubertal children. Interestingly, the occurrence of MAFLD was not significantly increased with BMI. Obese children and adolescents with disorders of carbohydrate metabolism, hypertriglyceridemia, elevated SBP, and insulin resistance should undergo abdominal ultrasound routinely for early detection of MAFLD and prevention of its complication.
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