Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Paper
  • Published:

Hepatic steatosis in obese Chinese children

International Journal of Obesity volume 28, pages 1257–1263 (2004)Cite this article

Abstract

OBJECTIVES: The aims of our study were: (1) to determine the prevalence of asymptomatic hepatic steatosis and presumed nonalcoholic steatohepatitis, in our local population of obese Chinese children referred for medical assessment; and (2) to assess the correlation between severity of ultrasonographic hepatic steatosis and degree of obesity, insulin resistance and serum biochemical abnormalities.

DESIGN: Cross-sectional study.

METHODS: In total, 84 obese children, 25 girls and 59 boys with median age and body mass index (BMI) of 12.0 years (interquartile range (IR): 9.5–14.0) and 30.3 kg/m2 (IR: 27.1–33.4), respectively, referred for medical assessment were studied. All subjects underwent physical examination, anthropometric and dual energy X-ray absorptiometry (DEXA) scan measurements and real-time ultrasonographic (US) examination of the liver. Fasting blood samples were collected for the measurement of liver function, hepatitis status, levels of serum glucose and insulin and lipid profile. Degree of fatty infiltration of the liver was graded according to ultrasonic appearance of liver echotexture, liver–diaphragm differentiation in echo amplitude, hepatic echo penetration and clarity of hepatic blood vessels.

RESULTS: All recruited subjects had no history of alcohol abuse and tests for Hepatitis B or C virus were negative. Thorough examination showed all of them to be in general good health without signs of chronic liver disease. Hepatic steatosis identified by defined ultrasonic appearances was diagnosed in 65 subjects (77%); 17 girls and 48 boys. The severity of fatty liver was positively related to anthropometric measurements including BMI, waist and hip circumference, subscapular skinfold thickness; insulin resistance markers [QUICKI and homeostasis model assessment (HOMA)], and hypertriglyceridaemia. Multvariate ordinal regression analysis showed that BMI and raised alanine aminotransferase (ALT) were positively associated with fatty liver. Combination of hepatic steatosis with raised ALT (presumptive NASH) was found in 19 subjects (24%). This group of patients had significantly higher waist hip ratio and conicity index compared to those with isolated hepatic steatosis. Boys with presumed NASH were also found to have significantly higher insulin resistance.

CONCLUSION: Nonalcoholic fatty liver disease (NAFLD) was common among our cohort of obese children referred for medical assessment. The prevalence of simple steatosis and presumed NASH was 77 and 24%, respectively. The severity of US steatosis was positively correlated with BMI, raised ALT, insulin resistance and hypertryglyceridaemia. Ultrasonography being noninvasive and readily available could be used for the monitoring of the progression of hepatic steatosis. Further longitudinal studies are required to determine the natural disease progression and the role of insulin resistance and other factors in the pathophysiology of NAFLD.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Stephen CH, tri HL, Stacey MA . Non alcoholic steatohepatitis. In: Textbook. Schiff's disease of the liver., 9th edn. Lippinott William & Wilkins: Philadelphia, PA; 2002. pp 1261–1289.

    Google Scholar 

  2. Clark JM, Brancati FL, Diehl AE . Nonalcoholic fatty liver disease: the most common cause of abnormal liver enzymes in the US population. Gastroenterology 2001; 120: A-65.

    Article  Google Scholar 

  3. WHO. (1999) Obesity: preventing and managing the global epidemic: report of a WHO consultation WHO Technical Report Series; 894 the office of Publication. World Health Organization: Geneva, Switzerland.

  4. Bellentani S, Saccoccio G, Masutti F, Saccoccio G, Tiribelli C . Prevalence of and risk factors for hepatic steatosis in northern Italy. Ann Intern Med 2000; 132: 112–117.

    Article  CAS  Google Scholar 

  5. Marceau P, Biron S, Hould FS, Marceau S, Simard S, Thung SN, Kral JG . Liver pathology and the metabolic syndrome X in severe Obesity. J Clin Endocrinol Metab 1999; 84: 1513–1517.

    Article  CAS  Google Scholar 

  6. Nomura H, Kashiwagi S, Hayashi J, Kajiyama W, Tani S, Goto M . Prevalence of fatty liver in general population of Okinawa, Japan. Jpn J Med 1988; 27: 142–149.

    Article  CAS  Google Scholar 

  7. Tominaga K, Kurata JH, Chen YK, Fujimoto E, Miyagawa S, Abe I, Kusano Y . Prevalence fatty liver in Japanese children and relationship to obesity: an epidemiological ultrasonographic survey. Dig Dis Sci 1995; 40: 2002–2009.

    Article  CAS  Google Scholar 

  8. Foster KJ, Dewbury KC, Griffith AH, Wright R . The accuracy of ultrasound in the detection of fatty infiltration of the liver. Br J Radiol 1980; 53: 440–442.

    Article  CAS  Google Scholar 

  9. Franzese A, Vajro P, Argenziano A, Puzziello A, Iannucci MP, Saviano MC, Brunetti F, Rubino A . Liver involvement in obese children: ultrasonography and liver enzyme levels at diagnosis and during follow-up on an Italian population. Dig Dis Sci 1997; 42: 1428–1432.

    Article  CAS  Google Scholar 

  10. Joseph AE, Saverymuttu SH, Al-Sam S, Cook MG, Maxwell JD . Comparison of liver histology with ultrasonography in assessing diffuse parentchymal liver disease. Clin Radiol 1991; 43: 26–31.

    Article  CAS  Google Scholar 

  11. Angelico F, Ben MD, Conti R, Francioso S, Feole K, Macciono D, Antonini TM, Alessandri C . Non-alcoholic liver disease: non-alcoholic fatty liver syndrome: a hepatic consequence of common metabolic diseases. J Gastroenterol Hepatol 2003; 18: 588–594.

    Article  Google Scholar 

  12. Knobler H, Schattner A, Zhornicki T, Malnick SDH, Keter D, Sokolovskaya N, Luric Y, Bass DD . Fatty liver—an additional and treatable feature of the insulin resistance syndrome. QJM 1999; 92: 73–79.

    Article  CAS  Google Scholar 

  13. Malnick SDH, Beergabel M, Knoblker H . Non—alcoholic fatty liver: a common manifestation of a metabolic disorder. QJM 2003; 96: 699–709.

    Article  CAS  Google Scholar 

  14. Day CP, James OFW . Steatohepatitis: a tale of two ‘hits’? Gastroenterology 1998; 114: 842–845.

    Article  CAS  Google Scholar 

  15. Schwimmer JB, Deutsch R, Rauch JB, Behling C, Newbury R, Lavine JE . Obesity, insulin resistance, and other clinicopathological correlates of pediatric non-alcoholic fatty liver disease. J Pediatr 2003; 143: 500–505.

    Article  Google Scholar 

  16. Leung SS, Lau JT, Tse LY, Oppenheimer SJ . Weight for age and weight for height references for Hong Kong children from birth to 18years. J Paediatr Child Health 1996; 32: 103–109.

    Article  CAS  Google Scholar 

  17. Tanner JM . Physical growth and development. In: Forfar JO, Arneil GC (eds) Textbook of paediatrics. Churchill Livingstone: Edinburgh; 1984. pp 304–305.

    Google Scholar 

  18. Durnin JVGA, Womersley J . Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 1974; 32: 77–97.

    Article  CAS  Google Scholar 

  19. Evans DJ, Hoffman RG, Kalkhoff RK, Kissebah AH . Relationship of body fat topography to insulin sensitivity and metabolic profiles in premenopausal women. Metabolism 1984; 33: 68–75.

    Article  CAS  Google Scholar 

  20. Valdez R, Seidell JC, Ahn YI, Weiss KM . A new index of abdominal adiposity as an indicator of risk for cardiovascular disease. A cross-population study. Int J Obes Relat Metab Disord 1993; 17: 77–82 Abstract-EMBASE.

    CAS  PubMed  Google Scholar 

  21. Cole TJ, Bellizi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity: international survey. BMJ 2000; 320: 1240–1243.

    Article  CAS  Google Scholar 

  22. Friedewald WT, Levy RI, Fredrickson DS . Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18: 499–502.

    CAS  Google Scholar 

  23. Conwell LS, Trost SG, Brown WJ, Batch JA . Indexes of insulin resistance and secretion in obese children and adolescents: a validation study. Diabetes Care 2004; 27: 314–319.

    Article  Google Scholar 

  24. Ludwig J, Viggiano TR, McGill DB, Oh BJ . Non-alcoholic steatohepatitis. Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clinic Proc 1980; 55: 434–438.

    CAS  Google Scholar 

  25. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, Mccullough AJ . Nonalcoholic fatty liver diease: a spectrum of clinical and pathological severity. Gastroenterology 1999; 116: 1413–1419.

    Article  CAS  Google Scholar 

  26. Giulio M, Mara B, Antonio ML, Morselli-Labate, Giampaolo B, Elisabetta B, Arthur J, McCullough, Gabriele F, Nazario M . Association of nonalcoholic fatty liver disease with insulin resistance. Am J Med 1999; 107: 450–455.

    Article  Google Scholar 

  27. Sonsuz A, Basaranoglu M, Bilir M, Senturk H, Akin P . Hyperinsulinemia in nondiabetic, both obese and nonobese patients with non-alcoholic stratohepatitis. Am J Gastroenterol 2002; 97: 495.

    Article  Google Scholar 

  28. Lee ZSK, Critchley JAJH, Ko GTC, Anderson PJ, Thomas GN, Young RP, Chan TY, Cockram CS, Tomlinson B, Chan JC . Obesity and cardiovascular risk factors in Hong Kong Chinese. Obes Rev 2002; 3: 173–182.

    Article  CAS  Google Scholar 

  29. Steinberger J, Daniels SJ . Obesity, insulin resistance, diabetes, and cardiovascular risk in children. Circulation 2003; 107: 1448–1453.

    Article  Google Scholar 

  30. Steinberger J, Moorehed C, Katch V, Rocchini AP . Relationship between insulin resistance and abnormal lipid profile in obese adolescents. J Pedatr 1995; 126: 690–695.

    Article  CAS  Google Scholar 

  31. Kawasaki T, Hashimoto N, Kikuchi T, Takahashi H, Uchiyama M . The relationship between fatty liver and hyperinsulinaemia in obese Japanese children. J Pediatr Gastroenterol Nutr 1997; 24: 317–321.

    Article  CAS  Google Scholar 

  32. Rashid M, Roberts EA . Nonalcoholic steatohepatitis in children. J Pedatri Gastroenterol Nutr 2000; 30: 48–53.

    Article  CAS  Google Scholar 

  33. Leung SS, Lau JT, Tse LY, Oppenheimer SJ . Weight for age and weight for height references for Hong Kong children from birth to 18years. J Paediatr Child Health 1996; 32: 103–109.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR

    D F Y Chan, A M Li, J Yin, T F Fok & E A S Nelson

  2. Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Shatin, Hong Kong SAR

    W C W Chu & E K H Liu

  3. Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR

    M H M Chan, I H S Chan & C W K Lam

  4. Centre for Epidemiology and Biostatistics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR

    E M C Wong

Authors
  1. D F Y Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A M Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W C W Chu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M H M Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E M C Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E K H Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. I H S Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C W K Lam
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. T F Fok
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. E A S Nelson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D F Y Chan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chan, D., Li, A., Chu, W. et al. Hepatic steatosis in obese Chinese children. Int J Obes 28, 1257–1263 (2004). https://doi.org/10.1038/sj.ijo.0802734

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0802734

Keywords

This article is cited by

Search

Advanced search

Quick links