FATTY LIVER DISEASE AND INSULIN SENSIVITY INDEXES IN OBESE CHILDREN AND ADOLESCENTS: PN1-05

Non-alcoholic fatty liver disease (NAFLD) is now recognised as an emerging clinical problem in children and adolescents. The prevalence of NAFLD is probably increasing parallel to prevalence of obesity. Paediatric NAFLD occurs most frequently in conditions associated to insulin resistance. Aims: (1) to describe the clinical and biochemical characteristics of NAFLD in obese paediatric population; and (2) to determine the association between NAFLD and insulin sensitivity indexes and degree of obesity. Methods: A total of 89 obese children/adolescents with NAFLD (mean age: 10 years old; 4 to 17 years old range; 47 girls) were examined. Body mass index (BMI) and percent body fat (%BF) were calculated. Serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, gamma-glutamyl transferase, fasting insulin and glucose, lipid profile of all patients were recorded. The diagnosis of NAFLD was based on ultrasound scan criteria. Homeostasis model assessment of insulin resistance (HOMA-IR), HOMA of percent β-cell function (HOMA-B%), insulinogenic index and the quantitative insulin sensitivity check index (QUICKI) were used to evaluate insulin sensitivity in all subjects. A group of 81 age and sex matched control obese subjects was included. Results: Central pattern of fat distribution was present in 70.8% of the subjects. Acanthosis nigricans (AN) was observed in 8 cases. Hypercholesterolemia, hypertriglyceridemia and raised ALT were found in 9 (10.1%), 41 (46.1%) and 43 (48.3%) subjects, respectively. The criteria for IR were met by 97.4% of subjects. The obese children with NAFLD had significantly higher blood pressure, BMI Zscore, %BF and IR when compared to the control group. Logistic regression determined the combination BMI Zscore and IR to be a strong predictor of NAFLD (p < 0.05). A positive association between AN and IR (p = 0.019) was also observed. Conclusions: In this study, NAFLD was predicted by the combination of quantitative insulin sensitivity indexes (HOMA-IR and QUICKI) and BMI Zscore. Consistent to other reports, acanthosis nigricans could be a reliable cutaneous marker of insulin resistance in obese children. Zscore. Consistent to other reports, acanthosis nigricans could be a reliable cutaneous marker of insulin resistance in obese children.