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FACTORS CONTRIBUTIG TO TRANSAMINITIS IN OBESE AND OVERWEIGHT PEDIATRIC PATIENTS
C Jimenez-Rivera, I Gaboury, S Hadjiyannakis
BACKGROUND: Non- Alcoholic Fatty Liver Disease (NAFLD) is a spectrum of liver diseases that ranges from benign fatty infiltration of the liver to cirrhosis and hepatic failure. It is the most common liver abnormality of adolescents. Obesity is considered the most important risk factor. In its development insulin resistance, hyperinsulinemia and lipid metabolism abnormalities are also thought to predispose the liver to becoming steatotic. Elevation of transaminase levels occurs in approximately 12-20% in the pediatric obese population and it is a biochemical marker of non-alcoholic steatohepatitis.
AIM: To evaluate whether insulin resistance, degree of obesity or plasma lipids were associated with elevation of alanine transaminase (ALT) levels in a pediatric population.
METHODS: The charts of overweight (body mass index: BMI >85 to <95th percentile) and obese (BMI >95th percentile) children referred to Endocrinology between February 2002 and February 2007 were reviewed. The data regarding abnormal ALT (>40 IU/L), fasting glucose, 2-hour post glucose tolerance test, fasting high-density lipoprotein (HDL) cholesterol and triglyceride levels and fasting insulin levels were captured. Abnormal ALT was analyzed in relation to the homeostasis model assessment of insulin resistance (HOMA-IR), BMI Z-score, serum fasting triglyceride and glucose levels as well as to HDL cholesterol levels.
RESULTS: There were 288 children included in the study. Gender distribution revealed female predominance (59%). Mean age was 12.5 years (SDą3.1). Mean BMI-Z score was 5.0 (SDą2.1, range 0.96 to 15.1). Elevation of ALT was found in 23.5% (95%CI: 18.7, 29.0) of children. In the univariate analysis, HOMA-IR (OR=1.1, p = 0.015), BMI Z-score (OR=1.3, p<0.001), HDL < 1mmol/L (OR=2.8, p=0.001) and serum fasting glucose >5.7 mmol/L (OR=2.2,p=0.010) were significantly associated to elevated ALT. High triglyceride fasting levels and 2hr post-glucose tolerance test did not show a significant correlation with transaminitis.
CONCLUSION: Elevation of ALT is predicted to occur in those children with evidence of insulin resistance, low serum HDL, high serum fasting glucose levels and are either overweight or obese.