Predictors of non-alcoholic fatty liver disease (NAFLD) among children with obesity

Abstract

Background The prevalence of childhood obesity and its related comorbidities in Malaysia are alarming. Malaysia ranked second in childhood obesity among South-east Asian countries with a prevalence of 12.7%. This study was conducted to investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) among obese children and to ascertain the predictors associated with NAFLD. Methods NAFLD was diagnosed via ultrasonographic evidence of fatty liver in obese and overweight children who presented to the Paediatric Obesity Clinic of University Malaya Medical Centre (UMMC), Malaysia. Demographic, anthropometric, clinical and biochemical parameters were analysed and compared between the NAFLD and non-NAFLD groups. Statistical analyses were carried out. Results Twenty-one out of 33 obese and overweight children (63.6%) were found to have NAFLD. We found that 62% of our study population in the NAFLD group had metabolic syndrome based on the definition by the International Diabetes Federation (IDF). Mean body mass index (BMI), waist circumference (WC), triglyceride (TG) and alanine aminotransferase (ALT) were found to be significantly greater in the NAFLD group compared to the non-NAFLD group (35.2 [6.1] vs. 29.3 [4.7] kg/m2 [p-value 0.007]; 104.1 [11.4] vs. 94.1 [12] cm [p-value 0.034]; 1.5 [0.9] vs. 0.9 [0.3] mmol/L [p-value 0.002]; 60.7 [53.8] vs. 27.3 [13] U/L [p-value 0.007]). Multivariate regression analysis revealed TG as the independent predictor for NAFLD, with an odds ratio of 41.7 (95% confidence interval [CI] 0.001, 0.819) (p-value 0.04). Conclusions Prevalence of NAFLD among children who are obese and overweight is alarming with 62% having metabolic syndrome. TG was found to be a strong predictor for NAFLD.

Keywords: BMI; childhood obesity; non-alcoholic fatty liver disease (NAFLD); paediatric; ultrasonography.