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  • Original Article
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Predictors of non-alcoholic fatty liver disease in obese children



To evaluate predictors of non-alcoholic fatty liver disease (NAFLD) in obese children.


Cross-sectional study.


Two hundred and sixty-eight obese children not consuming alcohol and without hepatitis B or C were consecutively studied at an auxology clinic.


Alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl-transferase (GGT), cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, triglycerides, uric acid, glucose, glucose during oral glucose tolerance testing (OGTT), insulin, insulin during OGTT, insulin resistance as estimated by homeostasis model assessment (HOMA), C-reactive protein (CRP), and systolic and diastolic blood pressure were measured. Fatty liver was diagnosed by ultrasonography using standard criteria. Univariable and multivariable logistic regression was used to evaluate predictors of NAFLD. All predictors except gender and pubertal status were modeled as continuous variables.


NAFLD was detected in 44% of obese children. At univariable analysis, male gender, Z-score of body mass index (BMI) (Z-BMI), ALT, AST, GGT, triglycerides, uric acid, glucose, glucose during OGTT, insulin, insulin during OGTT, HOMA, CRP and systolic blood pressure were predictors of NAFLD, whereas HDL-cholesterol and late-pubertal status were predictors of the normal liver. At multivariable analysis, however, only Z-BMI, ALT, uric acid, glucose during OGTT and insulin during OGTT were independent predictors of NAFLD.


Z-BMI, ALT, uric acid, glucose during OGTT and insulin during OGTT are independent predictors of NAFLD in Italian obese children, with most of the prediction explained by ALT and Z-BMI.


Centro Studi Fegato and Progetti di Ricerca Corrente, Istituto Auxologico Italiano.

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  • Bedogni G, Bellentani S (2004). Fatty liver: how frequent is it and why? Ann Hepatol 3, 63–65.

    PubMed  Google Scholar 

  • Bedogni G, Miglioli L, Masutti F, Castiglione A, Tiribelli C, Bellentani S (2004). Accuracy of body mass index in detecting an elevated alanine aminotransferase level in adolescents. Ann Hum Biol 31, 570–577.

    Article  CAS  Google Scholar 

  • Bedogni G, Miglioli L, Masutti F, Tiribelli C, Marchesini G, Bellentani S (2005). Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study. Hepatology 42, 44–52.

    Article  Google Scholar 

  • Bellentani S, Pozzato G, Saccoccio G, Crovatto M, Crocè LS, Mazzoran L et al. (1999). Clinical course and risk factors of hepatitis C virus related liver disease in the general population: report from the Dionysos study. Gut 44, 874–880.

    Article  CAS  Google Scholar 

  • Bonora E, Targher G, Alberiche M, Bonadonna RC, Saggiani F, Zenere MB et al. (2000). Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care 23, 57–63.

    Article  CAS  Google Scholar 

  • Brea A, Mosquera D, Martín E, Arizti A, Cordero JL, Ros E (2005). Nonalcoholic fatty liver disease is associated with carotid atherosclerosis: a case–control study. Arterioscler Thromb Vasc Biol 25, 1045–1050.

    Article  CAS  Google Scholar 

  • Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC et al. (2004). Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 40, 1387–1395.

    Article  Google Scholar 

  • Brunt EM (2004). Nonalcoholic steatohepatitis. Semin Liver Dis 24, 3–20.

    PubMed  Google Scholar 

  • Cacciari E, Milani S, Balsamo A, Dammacco F, De Luca F, Chiarelli F et al. (2002). Italian cross-sectional growth charts for height, weight and BMI (6–20 years). Eur J Clin Nutr 56, 171–180.

    Article  CAS  Google Scholar 

  • Chan DF, Li AM, Chu WC, Chan MH, Wong EM, Liu EK et al. (2004). Hepatic steatosis in obese Chinese children. Int J Obes Relat Metab Disord 28, 1257–1263.

    Article  CAS  Google Scholar 

  • Clark JM, Brancati FL, Diehl AM (2003). The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol 98, 960–967.

    Article  CAS  Google Scholar 

  • Hosmer D, Lemeshow S (2000). Applied Logistic Regression. John Wiley: New York.

    Book  Google Scholar 

  • Iughetti L, De Simone M, Bernasconi S, Predieri B, Battistini N, Bedogni G (2004). Relationship between body mass index and insulin measured during oral glucose tolerance testing in severely obese children and adolescents. Ann Hum Biol 31, 196–201.

    Article  CAS  Google Scholar 

  • Joseph AE, Saverymuttu SH, al-Sam S, Cook MG, Maxwell JD (1991). Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease. Clin Radiol 43, 26–31.

    Article  CAS  Google Scholar 

  • Kawasaki T, Hashimoto N, Kikuchi T, Takahashi H, Uchiyama M (1997). The relationship between fatty liver and hyperinsulinemia in obese Japanese children. J Pediatr Gastroenterol Nutr 24, 317–321.

    Article  CAS  Google Scholar 

  • Kinugasa A, Tsunamoto K, Furukawa N, Sawada T, Kusunoki T, Shimada N (1984). Fatty liver and its fibrous changes found in simple obesity of children. J Pediatr Gastroenterol Nutr 3, 408–414.

    Article  CAS  Google Scholar 

  • Lavine JE, Schwimmer JB (2004). Nonalcoholic fatty liver disease in the pediatric population. Clin Liver Dis 8, 549–558.

    Article  Google Scholar 

  • Lohman TG, Roche AF, Martorell R (1990). Anthropometric Standardization Reference Manual. Human Kinetics Books: Champaign, IL.

    Google Scholar 

  • Lonardo A, Loria P, Leonardi F, Borsatti A, Neri P, Pulvirenti M et al. (2002). Fasting insulin and uric acid levels but not indices of iron metabolism are independent predictors of non-alcoholic fatty liver disease. A case–control study. Dig Liver Dis 34, 204–211.

    Article  CAS  Google Scholar 

  • Mandato C, Lucariello S, Licenziati MR, Franzese A, Spagnuolo MI, Ficarella R et al. (2005). Metabolic, hormonal, oxidative, and inflammatory factors in pediatric obesity-related liver disease. J Pediatr 147, 62–66.

    Article  CAS  Google Scholar 

  • Marchesini G, Bugianesi E, Forlani G, Cerrelli F, Lenzi M, Manini R et al. (2003). Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 37, 917–923.

    Article  Google Scholar 

  • Matsuda M, DeFronzo RA (1999). Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 22, 1462–1470.

    Article  CAS  Google Scholar 

  • Molleston JP, White F, Teckman J, Fitzgerald JF (2002). Obese children with steatohepatitis can develop cirrhosis in childhood. Am J Gastroenterol 97, 2460–2462.

    Article  Google Scholar 

  • National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004). The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114, 555–576.

  • Neuschwander-Tetri BA, Caldwell SH (2003). Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference. Hepatology 37, 1202–1219.

    Article  Google Scholar 

  • Park SH, Kim BI, Yun JW, Kim JW, Park DI, Cho YK et al. (2004). Insulin resistance and C-reactive protein as independent risk factors for non-alcoholic fatty liver disease in non-obese Asian men. J Gastroenterol Hepatol 19, 694–698.

    Article  CAS  Google Scholar 

  • Saverymuttu SH, Joseph AE, Maxwell JD (1986). Ultrasound scanning in the detection of hepatic fibrosis and steatosis. Br Med J (Clin Res Ed) 292, 13–15.

    Article  CAS  Google Scholar 

  • Schwimmer JB, Behling C, Newbury R, Deutsch R, Nievergelt C, Schork NJ et al. (2005). Histopathology of pediatric nonalcoholic fatty liver disease. Hepatology 42, 641–649.

    Article  Google Scholar 

  • Schwimmer JB, Deutsch R, Rauch JB, Behling C, Newbury R, Lavine JE (2003). Obesity, insulin resistance, and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease. J Pediatr 143, 500–505.

    Article  Google Scholar 

  • Tanner J (1990). Foetus into Man (revised edition). Harvard University Press: Cambridge.

    Google Scholar 

  • Wallace TM, Levy JC, Matthews DR (2004). Use and abuse of HOMA modeling. Diabetes Care 27, 1487–1495.

    Article  Google Scholar 

  • Weston SR, Leyden W, Murphy R, Bass NM, Bell BP, Manos MM et al. (2005). Racial and ethnic distribution of nonalcoholic fatty liver in persons with newly diagnosed chronic liver disease. Hepatology 41, 372–379.

    Article  Google Scholar 

  • Yu AS, Keeffe EB (2003). Elevated AST or ALT to nonalcoholic fatty liver disease: accurate predictor of disease prevalence? Am J Gastroenterol 98, 955–956.

    Article  CAS  Google Scholar 

  • Zhou XH, Obuchowski NA, McClish DK (2002). Statistical Methods in Diagnostic Medicine. John Wiley: New York.

    Book  Google Scholar 

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Correspondence to G Bedogni.

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Guarantors: A Sartorio and G Bedogni.

Contributors: AS coordinated the study; ADC, FA and GM performed data collection; SB and CT contributed to the manuscript; GB performed statistical analysis and wrote the manuscript.

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Sartorio, A., Del Col, A., Agosti, F. et al. Predictors of non-alcoholic fatty liver disease in obese children. Eur J Clin Nutr 61, 877–883 (2007).

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