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Serum Retinol-binding Protein 4 Is Independently Associated With Pediatric NAFLD and Fasting Triglyceride Level

Huang, Shu-Ching*; Yang, Yao-Jong

Journal of Pediatric Gastroenterology and Nutrition: February 2013 - Volume 56 - Issue 2 - p 145–150
doi: 10.1097/MPG.0b013e3182722aee
Original Articles: Hepatology and Nutrition

Objectives: Nonalcoholic fatty liver disease (NAFLD) is identified as a major liver disease in children. The present study aimed to identify the prevalence and predictors of pediatric NAFLD and the correlation between serum retinol-binding protein 4 (RBP4) levels and metabolic characteristics in children.

Methods: A total of 748 schoolchildren, ages 6 to 12 years, were enrolled in 2009. The body weight and height were measured in the morning before intake. Laboratory tests included overnight fasting serum lipids, insulin, liver enzymes, and RBP4 levels. Hepatic steatosis was determined by ultrasound in 219 volunteers.

Results: The rates of NAFLD were 3% in the normal-weight, 25% in the overweight, and 76% in the obese children. Twenty (22%) of obese children had abnormal alanine aminotransferase (ALT) levels. In children with NAFLD, younger age and higher body mass index (BMI), insulin/homeostasis model of assessment, and male sex rate were associated with abnormal liver function. Stepwise increments in BMI, insulin, homeostasis model of assessment, and ALT were found in children with normal livers to simple steatosis, and to steatosis with abnormal ALT. Multiple logistic regression analysis confirmed that serum RBP4 levels (P = 0.048), ALT (P = 0.048), and BMI (P < 0.001) were independently predictors of pediatric NAFLD. Moreover, multiple linear regression analysis revealed that only serum triglycerides levels were positively related to RBP4 levels (P < 0.001).

Conclusions: Higher RBP4 and ALT levels as well as BMI are independently associated with pediatric NAFLD in Taiwan. In addition, an increment in RBP4 levels was positively correlated to hypertriglyceridemia in children.

*Department of Pediatrics, Kuo General Hospital

Department of Pediatrics, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan.

Address correspondence and reprint requests to Yao-Jong Yang, MD, PhD, Department of Pediatrics, National Cheng Kung University and Hospital, #138, Sheng Li Road, Tainan 704, Taiwan (e-mail:

Received 17 January, 2012

Accepted 31 August, 2012

The study was supported by grant KGH-9825 from Kuo General Hospital, Tainan, Taiwan, and DOH098-TD-F-113–098031–2 from the Department of Health, Taiwan.

The authors report no conflicts of interest.

Copyright 2013 by ESPGHAN and NASPGHAN