Objective: Waist circumference (WC) is widely accepted as risk factor for cardiovascular disease and metabolic syndrome (MS). Waist circumference may represent a marker of more severe inflammatory and/or fibrotic evolution in liver architecture in children affected by non alcoholic fatty liver disease (NAFLD).
Design: Cross-sectional study.
Setting: Ospedale Pediatrico Bambino Gesu'.
Patients: 197 children and adolescents with biopsy proven NAFLD.
Main outcome measures: waist circumference, percentile of waist circumference and ratio to height (waist to height ratio, WHtR); prevalence of MS; insulin sensitivity; insulin secretion; BMI z-score and total body fat (estimated by using dual-energy X-ray absorptiometry).
Results: BMI-z score, ≥2 SD was significantly associated with worst steatosis (P¡≤0.05), inflammation (P¡≤0.01), and NAS-score (P¡≤0.05); WHtR ¡≥0.5 with worst steatosis (P¡≤0.05); inflammation (P¡≤0.05); ballooning (P¡≤0.0001), fibrosis (P¡≤0.0001), and NAS-score (P¡≤0.01). In a logistic regression analysis model, percentile of waist circumference ¡≥90°, WHtR ¡≥0.5, and presence of MS predicted liver fibrosis with an explained variance of 80% (P¡≤0.0001).
Conclusions: Abdominal rather than general obesity may significantly contribute to liver fibrosis in children with fatty liver disease. Therefore, the presence of abdominal obesity, estimated by a high percentile of waist circumference and waist to height ratio, represents an additional clinical discriminator in the selection of children and adolescents to be subjected to further extensive clinical investigation, including liver biopsy.
- Liver fibrosis
- Metabolic syndrome
- Non Alcoholic SteatoHepatitis (NASH)
- Non-Alcoholic Fatty Liver Disease (NAFLD)
- Waist Circumference
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