Gender-specific prevalences of fatty liver in obese children and adolescents: roles of body fat distribution, sex steroids, and insulin resistance.
BACKGROUND
Nonalcoholic fatty liver disease (NAFLD) is known to have a gender-dimorphic prevalence in obese children. Less information is available on predictive factors for NAFLD in obese youths.


OBJECTIVE
The aim of the study was to examine the prevalence pattern and to identify clinical and laboratory markers associated with the risk for NAFLD.


METHODS
This was a cross-sectional study.


METHODS
The study setting was a rehabilitation clinic.


METHODS
A total of 532 obese subjects (291 girls) aged 8-19 yr participated in the study.


METHODS
Steatosis hepatis and visceral fat mass were determined by ultrasound. Laboratory tests included serum lipids, adiponectin, high-sensitivity C-reactive protein, sex steroids, and an oral glucose tolerance test.


RESULTS
Prevalence of hepatic steatosis was significantly higher in boys (41.1%) than in girls (17.2%) and was highest in postpubertal boys (51.2%) and lowest in postpubertal girls (12.2%). Severity of steatosis was associated with increased visceral fat mass, insulin resistance, lower adiponectin levels, and higher blood pressure. Three factors were extracted from the panel of investigated parameters by principal component analysis. Logistic regression analysis revealed significant associations of simple steatosis with the "insulin resistance and visceral fat" factor and the "body fat distribution and inflammation" factor in both genders and additionally with the "steroid hormones" factor in girls. Risk for steatosis hepatis with concomitantly elevated ALT was associated only with "insulin resistance and visceral fat" in girls and with all three factors in boys.


CONCLUSIONS
Our results suggest significant associations of NAFLD with markers of visceral obesity and insulin resistance in both genders and gender-specific associations with parameters of body fat distribution and sex steroids.
Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Hospital of Ulm, D-89075 Ulm, Germany.
Christian
C
Denzer
Dorothee
D
Thiere
Rainer
R
Muche
Wolfgang
W
Koenig
Hermann
H
Mayer
Wolfgang
W
Kratzer
Martin
M
Wabitsch
D000293:Adolescent; D050218:Body Fat Distribution; D002648:Child; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000097:blood / Q000209:etiology* / Q000378:metabolism; D005260:Female; D005951:Glucose Tolerance Test; D012739:Gonadal Steroid Hormones / Q000097:blood*; D006801:Humans; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000378:metabolism; D015995:Prevalence; D012737:Sex Factors; D055815:Young Adult
D012739:Gonadal Steroid Hormones