Esteatose hepática em crianças e adolescentes com excesso de peso: relação com os componentes da síndrome metabólica

Abstract

Introduction: Overweight in childhood especially in adolescence is associated with various comorbidities such as dyslipidemia, hypertension, insulin resistance, metabolic syndrome and nonalcoholic fatty liver disease. Objectives: Assessing the prevalence of fatty liver, liver enzyme profile and its association with components of metabolic syndrome in overweight children and adolescents. Methodology: Crosssectional study involving 152 children and adolescents treated in the public health system in Campina Grande-PB. Chi-square or Fisher's test and variance were used to compare groups according to presence or absence of hepatic steatosis and metabolic syndrome. The ability of liver enzymes to identify hepatic steatosis or the metabolic syndrome was evaluated through the use of a receiver operating characteristic curve (ROC). Statistical analysis was performed with SPSS version 17.0 using the confidence interval of 95%. Results: Hepatic steatosis was observed in 25.9% of children and adolescents with overweight / obesity, being more frequent among children (29.2%), boys (28.3%) and severely obese (30.1 %). Gamma-GT was associated with steatosis (p = 0.040), considering the cut off 24U / L. The average values of the liver enzymes increased significantly according to presence and degree of steatosis. The medium values of ALT and Gamma-GT were significantly higher in the group with MS. There was a higher mean insulin and HOMA-IR (p = 0.001) and a trend toward higher SBP (p = 0.052) in those who had no hepatic steatosis in liver enzymes showed a good cutoff point for the diagnostic of steatosis. Since the Gamma-GT in the value of 19.5 U/L was a good predictor of metabolic syndrome. Conclusions: The high prevalence of steatosis in the population studied (25.9%) and the absence of an appropriate cutoff point of liver enzymes for the diagnosis of this condition contributes to collect evidence about the need to perform ultrasonography in children and adolescents who are overweight and obesity as a criterion for assessment of hepatic steatosis. Changes in liver enzymes, especially Gamma-GT, are associated with metabolic syndrome, and with triglycerides.