Waist circumference as a marker for screening nonalcoholic fatty liver disease in obese adolescents

Clemente, Ana Paula Grotti; Dal Molin Netto, Bárbara; Carvalho-Ferreira, Joana Pereira de; Campos, Raquel Munhoz da Silveira; Ganen, Aline de Piano; Tock, Lian; Mello, Marco Túlio de; Dâmaso, Ana Raimunda

doi:10.1016/j.rppede.2015.10.004

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Revista Paulista de Pediatria

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Original Articles • Rev. paul. pediatr. 34 (1) • Jan-Mar 2016 • https://doi.org/10.1016/j.rppede.2015.10.004 copy

Waist circumference as a marker for screening nonalcoholic fatty liver disease in obese adolescents

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To assess the relationship between the degree of waist circumference (WC) and nonalcoholic fatty liver disease (NAFLD) in obese adolescents of both genders, analyzed according to quartiles of WC.

Methods:

Cross-sectional study that involved 247 obese adolescents aged 12–19 years. Mean values of the nutritional parameters and serum analyses were compared with the groups using the independent t-test. Pearson correlation coefficient was used to determine the relationship of the parameters studied. Chi-square test for trend was used to determine the relationship between the prevalence of the NAFLD and WC quartile by gender.

Results:

NAFLD were presented in 60% of the study participants. Obese adolescents in the 3rd and 4th quartiles of WC presented higher prevalence of NAFLD when compared with that in the 1st quartile in both genders. The NAFLD patients had significantly higher values for body weight, BMI (body mass index), BAZ-score (BMI-for-age z-scores), total fat (% and kg), WC, visceral fat, insulin, insulin resistance index (HOMA-IR), aspartate aminotransferase and alanine aminotransferase, when compared with non-NAFLD obese adolescents.

Conclusions:

In conclusion, the results presented here suggest that an increase in WC can reliably predict the risk of NAFLD in obese adolescents. This is a low cost and easy-to-use tool that can help in screening in adolescents.

KEYWORDS
Aspartate aminotransferase; Alanine aminotransferase; Abdominal fat; Adolescents

	NAFLD (n=40)	Non-NAFLD (n=50)	NAFLD (n=59)	Non-NAFLD (n=98	NAFLD (n=148)	Non-NAFLD (n=99)	p -value Boys	p -value Girls	Gender Group ^a a Comparison of the gender with NAFLD.	Gender Group ^b b Comparison of the gender with Non-NAFLD.	Total
Age (years)	16.78±1.63	15.87±1.65	16.94±2.10	16.30±1.80	16.88±1.92	16.15±1.76	0.01	0.04	0.67	0.15	0.02
Weight (kg)	117.07±17.24	100.48±16.08	100.69±15.45	91.13±13.75	107.31±18.02	94.29±15.19	<0.01	<0.01	<0.01	<0.01	<0.01
Height (cm)	174.65±6.77	171.34±8.18	163.37±6.85	162.53±5.93	167.92±8.77	165.50±7.93	0.04	0.41	<0.01	<0.01	0.03
BAZ (Z score)	3.51±0.83	3.04±0.65	3.25±0.80	2.82±0.69	3.36±0.82	2.89±0.68	0.04	0.01	0.07	0.23	<0.01
BMI (kg/m²)	38.37±4.95	34.08±4.10	37.71±4.98	34.46±4.52	37.97±4.95	34.33±4.38	<0.01	<0.01	0.52	0.64	<0.01
Total fat (%)	42.92±6.08	38.08±6.04	47.71±4.84	45.20±5.54	45.77±5.84	42.97±6.49	0.01	0.05	<0.01	<0.01	0.01
Fat free mass (%)	57.32±5.98	61.50±6.18	52.28±4.84	54.92±5.43	54.32±5.85	57.16±6.48	0.02	0.03	<0.01	<0.01	0.01
Total fat (kg)	50.72±12.25	38.96±9.96	48.35±10.47	41.37±10.28	49.31±11.22	40.55±10.20	<0.01	<0.01	0.31	0.17	<0.01
Fat free mass (kg)	66.52±9.76	62.58±10.95	52.28±6.97	49.31±5.02	58.04±10.77	53.82±9.83	0.08	0.05	<0.01	<0.01	0.02
WC (cm)	110.30±10.83	99.34±8.17	102.59±10.82	94.71±9.05	105.70±11.42	96.27±9.01	<0.01	<0.01	0.01	0.03	<0.01
Visceral fat (cm)	5.82±1.64	4.30±1.23	4.52±1.31	3.73±1.20	5.05±1.58	3.92±1.24	<0.01	<0.01	<0.01	0.22	<0.01
Subcutaneous fat (cm)	3.60±0.95	3.44±0.88	3.86±1.09	3.69±1.04	3.75±1.04	3.60±1.00	0.41	0.33	0.27	0.07	0.26
Glucose (mg/dL)	92.17±7.99	91.54±6.47	89.91±7.52	89.93±6.58	90.82±7.75	90.47±6.56	0.68	0.98	0.15	0.16	0.70
Insulin (uU/mL)	23.87±12.42	15.98±10.28	20.00±8.33	16.10±10.37	21.56±10.30	16.06±10.30	<0.01	0.01	0.06	0.95	<0.01
HOMA-IR	5.47±2.91	3.64±2.51	4.37±1.90	3.66±2.94	4.81±2.41	3.65±2.79	0.02	0.01	0.04	0.98	0.01
AST, U/L	32.30±14.00	24.36±6.23	22.08±4.88	21.77±6.31	26.21±10.84	22.64±6.38	0.02	0.74	<0.01	0.02	0.01
ALT, U/L	50.42±17.03	28.74±15.04	26.81±10.63	24.46±12.01	36.35±16.28	25.91±13.22	0.01	0.21	<0.01	0.06	<0.01

	Low: 1st (<91.8cm)		Moderate: 2nd (≥91.8–99cm)		High: 3rd (>99–107.5cm)		Very High: 4th (>107.5cm)
	Boys (n=51)	Girls (n=11)	Boys (n=45)	Girls (n=17)	Boys (n=32)	Girls (n=30)	Boys (n=28)	Girls (n=33)
BAZ (Z score)	2.49±0.31	2.66±0.29	2.86±0.46	2.73±0.28	3.29±0.58	3.09±0.54	3.77±0.61	3.82±0.61
BMI (kg/m²)	31.49±2.41	30.54±2.71	35.01±3.24	32.67±1.82 ^a a Difference of the genders at the same quartile.	38.09±4.06	35.32±3.66 ^a a Difference of the genders at the same quartile.	41.46±4.19	40.15±4.11
Total fat (%)	39.10±6.07	42.17±4.53	46.44±4.79	37.84±5.89 ^a a Difference of the genders at the same quartile.	48.70±4.39	39.16±6.15 ^a a Difference of the genders at the same quartile.	49.76±4.17	43.97±5.94 ^a a Difference of the genders at the same quartile.
WC (cm)	86.54±3.88	87.42±3.77	95.81±2.30	95.50±2.53	103.65±2.54	102.67±1.88	113.60±6.23	115.57±6.59
Visceral fat (cm)	3.48±1.12	3.96±1.17	4.06±1.06	3.76±1.15	4.19±1.52	5.07±1.33 ^a a Difference of the genders at the same quartile.	4.69±1.20	5.75±1.71
Subcutaneous fat (cm)	3.17±0.82	2.42±0.66 ^a a Difference of the genders at the same quartile.	3.66±0.72	3.44±0.83	4.37±1.03	3.58±0.68 ^a a Difference of the genders at the same quartile.	4.38±1.22	3.85±1.02
HOMA-IR	3.82±1.75	3.31±1.95	3.49±1.44	4.02±2.78	4.01±1.68	4.16±1.69	4.75±1.88	5.31±3.14
AST U/L	22.88±7.54	20.81±3.02	21.06±4.42	24.76±7.07	21.43±4.74	30.80±13.90 ^a a Difference of the genders at the same quartile.	21.39±4.42	29.48±10.43 ^a a Difference of the genders at the same quartile.
ALT U/L	25.50±14.30	19.27±6.72	24.08±10.08	29.58±13.22	26.12±10.42	30.80±13.90 ^a a Difference of the genders at the same quartile.	25.32±8.60	45.30±12.89 ^a a Difference of the genders at the same quartile.

	Girls (n=157)		Boys (n=90)
	Pearson R	p -value	Pearson R	p -value
BAZ (Z score)	0.722	0.001	0.731	0.001
BMI (kg/m²)	0.759	0.001	0.760	0.001
Total fat (%)	0.382	0.001	0.581	0.001
Visceral fat (cm)	0.504	0.001	0.306	0.001
Subcutaneous fat (cm)	0.424	0.001	0.470	0.001
HOMA-IR	0.384	0.001	0.128	0.111
AST, U/L	0.259	0.013	−0.041	0.610
ALT, U/L	0.324	0.002	0.109	0.615

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[1] * Corresponding author. E-mail:anagrotticlemente@gmail.com (A.P.G. Clemente).