title: Association of the components of the metabolic syndrome with non-alcoholic fatty liver disease among normal-weight, overweight and obese children and adolescents.
abstract: OBJECTIVE
  This study aimed to determine the prevalence of the metabolic syndrome, abnormalities of liver enzymes and sonographic fatty liver, as well as the inter-related associations in normal weight, overweight and obese children and adolescents.
  
  
  METHODS
  This cross-sectional study was conducted among a sample of 1107 students (56.1% girls), aged 6-18 years in Isfahan, Iran. In addition to physical examination, fasting blood glucose, serum lipid profile and liver enzymes were determined. Liver sonography was performed among 931 participants. These variables were compared among participants with different body mass index (BMI) categories.
  
  
  RESULTS
  From lower to higher BMI category, alanine aminotransferase (ALT), total cholesterol, LDL-cholesterol, triglycerides and systolic blood pressure increased, and HDL-cholesterol decreased significantly. Elevated ALT, aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were documented in respectively 4.1%, 6.6% and 9.8% of normal weight group. The corresponding figure was 9.5%, 9.8% and 9.1% in overweight group, and 16.9%, 14.9% and 10.8% in obese group, respectively. In all BMI categories, ALT increased significantly by increasing the number of the components of the metabolic syndrome. Odds ratio for elevated liver enzymes and sonographic fatty liver increased significantly with higher number of the components of the metabolic syndrome and higher BMI categories before and after adjustment for age.
  
  
  CONCLUSIONS
  Because of the interrelationship of biochemical and sonographic indexes of fatty liver with the components of the metabolic syndrome, and with increase in their number, it is suggested to determine the clinical impact of such association in future longitudinal studies.
authors.affiliation: Pediatric Preventive Cardiology Department, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. kroya@aap.net
authors.forename: Roya
authors.initials: R
authors.lastname: Kelishadi
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cook
authors.forename: Atoosa
authors.initials: A
authors.lastname: Adibi
authors.forename: Zahra
authors.initials: Z
authors.lastname: Faghihimani
authors.forename: Shohreh
authors.initials: S
authors.lastname: Ghatrehsamani
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Beihaghi
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Salehi
authors.forename: Noushin
authors.initials: N
authors.lastname: Khavarian
authors.forename: Parinaz
authors.initials: P
authors.lastname: Poursafa