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#Gastroenterology #Hepatology #Multispeciality
A study published in the Journal of Clinical Endocrinology & Metabolism, has suggested that obesity is associated with elevated markers of liver damage in children and adolescents. It has been observed that plasma concentrations of liver enzymes and bilirubin are commonly considered as a marker of liver injury. However, the age- and sex-specific effects of childhood overweight and obesity on these liver enzymes is yet not fully understood. The current study was conducted to estimate age- and sex-specific reference values for liver enzymes in children and adolescents. In addition, the researchers also evaluated the influence of adiposity.
The present study included two cohorts, a population-based cohort with 1858 normal-weight children and adolescents and a cohort with 2155 children and adolescents with overweight/obesity. These children were all aged 6 to 18 years. However, children and adolescents with overweight, obesity, or underweight in the population-based cohort were not included in the study in order to take only healthy normal-weight patients into consideration. Age- and sex-specific percentile curves were estimated for fasting plasma concentrations of alanine transaminase (ALT), aspartate transaminase (AST), lactate dehydrogenase (LDH), gamma glutamyl transferase (GGT), bilirubin, and alkaline phosphatase (ALP) in both cohorts.
The outcome revealed that concentrations of ALT and AST got reduced with age among normal-weight boys and girls in the population-based cohort. However, boys had higher ALT which was associated with increased standard deviation score for body mass index in comparison to girls. LDH concentrations were found to be reduced with age. No variation with age in boys or girls was seen in GGT concentrations. Although bilirubin concentration exhibited no alteration with age in girls, boys showed a modest increase in bilirubin with age. ALP levels primarily increased until reaching a peak at ages 11 to 12 years in girls and 13 to 14 years in boys, which further showed a steep reduction in both sexes.
When determined in the cohort of patients with overweight/obesity, ALT concentrations were elevated in both boys and girls with all age groups. Contrary to the population-based cohort, these levels increased significantly with age in children with overweight/obesity, which was more pronounced in boys >13 years of age. Moreover, a modest increase, related with age in GGT was seen in children with overweight or obesity, and this trend was seen to be more pronounced in boys.
In addition, the study also examined hepatic fat content with the help of proton magnetic resonance spectroscopy in 458 patients and analyzed the ability of ALT to recognize hepatic steatosis, which was typified by liver fat content >5%. The results demonstrated 25 girls (9.9%) and 44 boys (21%) were identified with hepatic steatosis. The optimal ALT cutoff point was 24.5 U/L for girls (sensitivity: 55.6%; specificity: 84.0%; area under the curve: 71.8%), and 34.5 U/L for boys (sensitivity: 83.7%; specificity: 68.2%; area under the curve: 79.1%).
Thus, the study concluded the raised plasma concentrations of ALT in both girls and boys with overweight or obesity might indicate the manifestation of nonalcoholic fatty liver disease or nonalcoholic steatohepatitis in majority of these children. The increased risk of incidence of these diseases warrants the need for appropriate treatment approaches in children with overweight and obesity.
Source: Liver Enzymes in Children, Adolescents Are Affected by Obesity. Available at: https://www.endocrinologyadvisor.com/home/topics/pediatric-endocrinology/liver-enzymes-in-children-are-affected-by-overweight-and-obesity/. Accessed on: 28-11-2020.