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Predictors of non-alcoholic fatty liver disease in children
Menglong Li1, Wen Shu1, Jiawulan Zunong1
1Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China.
Insights
Abdominal obesity indicators effectively screen for pediatric non-alcoholic fatty liver disease (NAFLD). Trunk fat index (TFI) demonstrated the highest predictive accuracy, aiding early intervention to prevent liver disease progression.
Area of Science:
- Pediatric Endocrinology
- Hepatology
- Obesity Research
Background:
- Abdominal obesity is a significant risk factor for pediatric non-alcoholic fatty liver disease (NAFLD).
- Early identification and intervention are crucial for managing NAFLD and preventing liver disease progression.
- Accurate screening tools are needed to identify at-risk children.
Purpose of the Study:
- To compare the discriminative performance of six abdominal obesity indicators for screening pediatric NAFLD.
- To identify the most effective indicator for predicting NAFLD in children.
- To establish optimal cut-off values for selected indicators.
Main Methods:
- A cohort of 1350 Chinese children aged 6-8 years was studied.
- Anthropometric (WC, WHR, WHtR), body composition (TFI, VFA), and endocrine (VAI) indicators were measured.
- Statistical analyses included Spearman correlation, ROC curves, and logistic regression to assess predictive ability.
Main Results:
- All six indicators showed robust NAFLD prediction (AUC 0.69-0.96).
- Trunk fat index (TFI), waist circumference (WC), and visceral fat area (VFA) were the top three predictors.
- TFI achieved the highest AUC (0.94 for boys, 0.96 for girls) with specific cut-off values.
Conclusions:
- User-friendly body composition indicators, such as TFI, are effective for identifying pediatric NAFLD.
- These indicators can facilitate early weight management and help prevent liver disease progression.
- TFI offers a reliable and interpretable screening tool for clinical practice.
Objective:
Abdominal obesity is strongly associated with the development of non-alcoholic fatty liver disease (NAFLD). Early identification and intervention may reduce the risk. We aim to improve pediatric NAFLD screening by comparing discriminative performance of six abdominal obesity indicators.
Methods:
We measured anthropometric indicators (waist circumference [WC], waist-to-hip ratio [WHR], waist-to-height ratio [WHtR]), body composition indicators (trunk fat index [TFI], visceral fat area [VFA]), and endocrine indicator (visceral adiposity index [VAI]) among 1350 Chinese children aged 6-8 years. Using Spearman correlation, receiver operating characteristic (ROC) curves, and Logistic regression, we validated their ability to predict NAFLD.
Results:
All six indicators can predict NAFLD robustly, with area under the curve (AUC) values ranged from 0.69 to 0.96. TFI, WC, and VFA rank in the top three for the discriminative performance. TFI was the best predictor with AUC values of 0.94 (0.92-0.97) and 0.96 (0.92-0.99), corresponding to cut-off values of 1.83 and 2.31 kg/m2 for boys and girls, respectively. Boys with higher TFI (aOR = 13.8), VFA (aOR = 11.1), WHtR (aOR = 3.1), or VAI (aOR = 2.8), and girls with higher TFI (aOR = 21.0) or VFA (aOR = 17.5), were more likely to have NAFLD.
Conclusion:
User-friendly body composition indicators like TFI can identify NAFLD and help prevent the progress of liver disease.
Trial Registration:
Chinese Clinical Trial Registry (ChiCTR) ( www.chictr.org.cn/enIndex.aspx , No. ChiCTR2100044027); retrospectively registered on 6 March 2021.
Impact:
Abdominal obesity increases the risk of pediatric non-alcoholic fatty liver disease (NAFLD). This study compared the discriminative performance of multiple abdominal obesity indicators measured by different methods in terms of accuracy and fastidious cut-off values through a population-based child cohort. Our results provided solid evidence of abdominal obesity indicators as an optimal screening tool for pediatric NAFLD, with area under the curve (AUC) values ranged from 0.69 to 0.96. User-friendly body composition indicators like TFI show a greater application potential in helping physicians perform easy, reliable, and interpretable weight management to prevent the progress of liver damage.
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