Comparison Of Clinical And Laboratory Indicators In Severe Obese Children With And Without Nonalcoholic Fatty Liver Disease And Its Clinical Significance

Objective:Compare and summarize the clinical and laboratory indicators of severe obese children with and without non-alcoholic fatty liver disease（NAFLD）,and discuss the differences of clinical,biochemical,and endocrine hormone indicators between the two groups,providing reference for the prevention and treatment of obese children with NAFLD.Subjects:78 children with severe simple obesity who were hospitalized in the Department of Endocrine Metabolism,Women’s and Children’s Hospital Affiliated to Qingdao University from May 2021 to November 2022 were selected.Based on the results of abdominal ultrasound examination,those children were divided into two groups.One group were composed of children with NAFLD（47,60%）and the other group were composed of children without NAFLD（34,43%）.Methods:All the children were measured height,blood pressure,weight,waist circumference（WC）,hip circumference（HC）,and body mass index（BMI）,waist to hip ratio（WHR）and waist to height ratio（WHt R）were calculated.Improve laboratory tests:sex hormone binding globulin,（SHBG）,progesterone（PROG）,luteinizing hormone（LH）,follicle stimulating hormone（FSH）,prolactin（PRL）,estradiol（E2）,testosterone（T）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）Triglycerides（TG）,total cholesterol（TC）,low density lipoprotein（LDL）,high density lipoprotein cholesterol（HDL）,glycosylated hemoglobin（Hb A1c）,fasting plasma glucose（FPG）and fasting insulin（FINS）.Oral glucose tolerance test（OGTT）was performed to calculate the area under insulin curve(AUC_INS),area under glucose curve(AUC_BG),and their ratio(IAUC_INS/AUC_BG),then calculated the insulin resistance index（HOMA-IR）and FPG/FINS（FGIR）.Take an AP radiograph of the left hand to assess bone age.Liver ultrasound was performed to determine whether there was fatty liver.All data were processed by statistic package deal SPSS 24.0.Variables of normal distribution were shown as mean±standard deviation（χ±s）and use t test to compare the two groups.Mann-Whitney test was used for skewness distribution data.Qualitative data analysis adopts chi square test.P<0.05,that was statistically significant differences.Results:78 children,including 22 females and 56 males,aged 11.7±2.55 years,were included in this study.All the children are severe abdominal obesity.27 cases（34.62%）had concomitant NAFLD with elevation of hepatic transaminases,those who hadn’t concomitant NAFLD were all with normal liver function.1.The WHR and WHt R of severe obese children with NAFLD were higher than those without NAFLD（P<0.05）.There was no statistically significant difference in BMI and blood pressure between the two groups（P>0.05）.2.There were 41 cases（52.56%）didn’t have dyslipidemia since 37 cases（47.44%）had abnormal blood lipid.The TG level of severe obese children with NAFLD was higher than that of those without NAFLD（P<0.05）,and there was no statistically significant difference in TC,LDL,and HDL between the two groups（P>0.05）.3.The results of HOMA-IR suggesting that 61 cases（88.5%）had insulin resistance（IR）.2 cases（2.56%）with impaired fasting glucose,17 cases（21.79%）with impaired glucose tolerance（including 2 cases with impaired fasting glucose）,and no children with complicated diabetes.There was no significant difference in Hb A1c,FPG,FINS,AUCINS,AUCBG,IAUCINS/AUCBG ratios,HOMA-IR,FGIR between severe obese children with and without NAFLD（P>0.05）.4.Among severe obese male children,39（69.64%）complicated by fatty liver,17（30.36%）were not.The SHBG level in NAFLD group was lower than that in the group without NAFLD.There was no significant difference in E2,T,E2/T,PROG,LH,FSH,and PRL between the two groups（P>0.05）.5.Among male severe obese children,32（57.14%）had bone age advanced and 24（42.86%）were not.There was no statistically significant difference in E2,T,E2/T,LH,FSH,PROG,PRL and SHBG levels between the bone age advanced group and those without bone age advanced.Conclusion:1.Fat distribution abnormalities and dyslipidemia are more severe in severe obese children with NAFLD.2.The incidence of IR is high in severe obese children,but abnormal glucose metabolism is not associated with the presence of NAFLD.3.The SHBG level of severe obese children with NAFLD is significantly lower than those without NAFLD,but the relationship between the lever of SHBG and the change of sexual characteristics in obese children needs further study.4.The changes of E2,T,E2/T ratio,and SHBG may not be major contributors to advanced bone age in severe obese children.