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Factors Associated With Hepatic Steatosis in Obese Children and Adolescents

Ruiz-Extremera, Ángeles*; Carazo, Ángel||; Salmerón, Ángela; León, Josefa||; Casado, Jorge||; Goicoechea, Alejandro#; Fernandez, José Manuel; Garofano, Maximiliano; Ocete, Esther*; Martín, Ana Belén||; Pavón, Esther||; Salmerón, Javier§

Journal of Pediatric Gastroenterology and Nutrition: August 2011 - Volume 53 - Issue 2 - p 196–201
doi: 10.1097/MPG.0b013e3182185ac4
Original Articles: Hepatologyand Nutrition

Objectives: Obesity is associated with high prevalence of hepatic steatosis. We speculate that determinant factors of susceptibility to hepatic steatosis in obesity could differ between children and adolescents.

Patients and Methods: Blood biochemical parameters, systemic oxidative stress markers, proinflammatory cytokines, and adipokine levels were determined in 157 obese children and adolescents. The subjects were divided into 2 groups: children and adolescents, identified as such in accordance with Tanner stage and the measured level of dehydroepiandrosterone sulphate. Steatosis was evaluated by ultrasonography in 127 subjects.

Results: Steatosis prevalence was 44.8%. In the “children” group, those with hepatic steatosis presented higher levels of erythrocyte oxidised glutathione (GSSG) and resistin, lower levels of high-density lipoprotein (HDL) cholesterol, and lower enzymatic activities of erythrocyte glutathione reductase (GRd) and glutathione oxidase (GPx). In the “adolescents” group, those with hepatic steatosis presented higher values for body mass index z score (BMIz), insulin, peptide C, homeostatic model assessment index (HOMA-IR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglycerides, GSSG, and leptin. These subjects also presented lower values for soluble leptin receptor, GRd, and GPx. In the “children” group, the only independent factor of steatosis was a decrease in GRd activity (odds ratio [OR] 0.165, 95% CI 0.03–0.84, P = 0.030). Moreover, in the “adolescent” group, the independent factors were higher for GSSG (OR 6.8, 95% CI 1.6–28.7, P = 0.010) and HOMA-IR (OR 1.9, 95% CI 1.17–3.1, P = 0.009).

Conclusions: Factors associated with hepatic steatosis differ between obese children and adolescents. Oxidative stress is seen to be the main process in children, whereas in adolescents oxidative stress and insulin resistance are significant factors for steatosis.

*Paedriatric Unit

Endocrinology Paedriatric Unit

Radiology Unit

§Gastroenterology Unit, San Cecilio University Hospital, Granada, Spain

||Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Instituto de Salud Carlos III, Majadahonda, Spain

Radiology Unit, Virgen de las Nieves University Hospital. Granada, Spain

#Consejería de Salud, Junta de Andalucía, Spain.

Address correspondence and reprint requests to Ángel Carazo, San Cecilio University Hospital, Research Unit, Avda de Madrid s/n, 18012 Granada, Spain (e-mail:

Received 15 September, 2010

Accepted 28 February, 2011

This work was supported in part by a grant from Ciberehd (Ciberehd is funded by the Instituto de Salud Carlos III) and by grants from Consejería de Salud, Junta de Andalucía, Spain.

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN