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Pediatrics

Sex-specific differences in ectopic fat and metabolic characteristics of paediatric nonalcoholic fatty liver disease

International Journal of Obesity volume 48, pages 486–494 (2024)Cite this article

Subjects

Abstract

Background/Objectives

Sex-specific differences in obesity-related metabolic characteristics of non-alcoholic fatty liver disease (NAFLD) have rarely been explored, particularly in children with biopsy-verified NAFLD. The influence of sex hormones on ectopic fat disposition may cause inter-sex differences in various metabolic factors. This study aimed to assess the sex-based differences in ectopic fat and metabolic characteristics in children with NAFLD.

Subject/Methods

We enrolled 63 children with biopsy-verified NAFLD (48 boys; mean age, 12.9 ± 3.2 years; mean body mass index z-score [BMI-z], 2.49 ± 1.21). Ectopic fat in the liver and pancreas was quantified based on magnetic resonance imaging within 2 days of the liver biopsy. Laboratory tests, body composition, blood pressure, and anthropometric measurements were also assessed.

Results

Sex-based differences were neither observed in age, BMI-z, or total body fat percentage nor in the proportions of obesity, abdominal obesity, diabetes, dyslipidaemia, hypertension, or metabolic syndrome. Furthermore, liver enzyme levels, lipid profiles, and pancreatic fat did not differ between the sexes. However, boys had significantly higher fasting insulin (median 133.2 vs. 97.8 pmol/L; p = 0.039), fasting plasma glucose (median 5.30 vs. 4.83 mmol/L; p = 0.013), homeostasis model assessment of insulin resistance (median 5.4 vs. 3.6; p = 0.025), serum uric acid (404.1 ± 101.2 vs. 322.4 ± 87.1 μmol/L; p = 0.009), and liver fat (median 26.3% vs. 16.3%; p = 0.014).

Conclusions

Male-predominant hepatic steatosis and insulin resistance caused by sex-specific ectopic fat accumulation may contribute to higher uric acid levels in boys than in girls with NAFLD.

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Fig. 1: Graphical presentation of significantly higher metabolic parameters in boys versus girls with nonalcoholic fatty liver disease.
Fig. 2: Graphical presentation of significantly different metabolic parameters between boys and girls with nonalcoholic fatty liver disease according to liver histologic steatosis grade.

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Data availability

The corresponding author (HRY) will review data availability on reasonable request.

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Acknowledgements

The present study received the 2019 Seokcheon Research Award from the Korean Pediatric Society. This study was assisted by the Division of Statistics in Medical Research Collaborating Center at Seoul National University Bundang Hospital.

Funding

This study was supported by the 2019 Research grant of the Korean Pediatric Society (Seokcheon Research Award).

Author information

Authors and Affiliations

  1. Department of Pediatrics, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea

    Eun Hye Lee

  2. Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea

    Ji Young Kim

  3. Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea

    Hye Ran Yang

  4. Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea

    Hye Ran Yang

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Contributions

Conceptualisation: HRY, EHL, Data curation: EHL, JYK, Formal analysis: EHL, HRY, Methodology: HRY, JYK, Investigation: EHL, JYK, Supervision: HRY, Writing-manuscript: EHL, Reviewing & correcting-manuscript: HRY, EHL.

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Correspondence to Hye Ran Yang.

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Lee, E.H., Kim, J.Y. & Yang, H.R. Sex-specific differences in ectopic fat and metabolic characteristics of paediatric nonalcoholic fatty liver disease. Int J Obes 48, 486–494 (2024). https://doi.org/10.1038/s41366-023-01439-6

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