Our aim was to evaluate incidence and risk factors of liver involvement in obese Italian children as assessed by both ultrasonographic and biochemical parameters. In seventy-five consecutive obese children (age 9.5 +/- 2.9 years, males/females 41/34), serum levels of enzymes and ultrasonography of the liver were evaluated. Tests were repeated one, three, and six months after starting a moderate hypocaloric diet and an exercise program. Three obese children who were found to have chronic viral hepatitis were excluded from the study. Thirty-eight of 72 (53%) obese children had an ultrasonographic image of bright liver consistent with liver steatosis. The latter was severe in nine children, moderate in 16, and mild in 13. Eighteen obese children (25%) had elevated transaminase levels. Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease. Both were rapidly responsive to loss of weight, confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved. Obesity duration not more than three years (odds ratio = 4.77), a higher degree of obesity (odds ratio = 2.09), and hypertransaminasemia (odds ratio = 2.15) appeared as important predictive factors of liver involvement at ultrasonography. Incidence of liver involvement assessed by means of ultrasonography is significantly higher than that revealed by measurement of serum liver enzymes. A short duration of obesity emerged as a potentially new risk factor of liver involvement in the pediatric obese population and needs to be confirmed in future studies.

译文

我们的目的是通过超声和生化参数评估肥胖的意大利儿童肝脏受累的发生率和危险因素。在75名连续肥胖儿童 (年龄9.5 +/- 2.9岁,男性/女性41/34) 中,评估了血清酶水平和肝脏超声检查。在开始适度的低热量饮食和锻炼计划后的一个月,三个月和六个月重复测试。3名被发现患有慢性病毒性肝炎的肥胖儿童被排除在研究之外。72名 (53% 名) 肥胖儿童中有38名具有明亮肝脏的超声图像,与肝脏脂肪变性一致。后者严重于9名儿童,中度于16名,轻度于13名。18名肥胖儿童 (25%) 的转氨酶水平升高。明亮的肝脏和高转氨酶血症不是由肝病的任何最常见原因引起的。两者都对体重减轻迅速反应,证实肝脏受累是继发于肥胖的,并且脂肪变性或脂肪性肝炎而不是纤维化。肥胖持续时间不超过三年 (优势比 = 4.77),较高的肥胖程度 (优势比 = 2.09) 和高转氨酶血症 (优势比 = 2.15) 是超声检查肝脏受累的重要预测因素。通过超声检查评估的肝脏受累发生率明显高于通过血清肝酶测量显示的肝脏受累发生率。短期肥胖已成为小儿肥胖人群肝脏受累的潜在新危险因素,需要在未来的研究中得到证实。

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