Clustering of metabolic risk factors is associated with high-normal levels of liver enzymes among 6- to 8-year-old children: the PANIC study.
BACKGROUND
We studied the associations of clustering of metabolic risk factors with plasma levels of alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) in healthy prepubertal children.


METHODS
The subjects were a representative population sample of 492 children 6-8 years of age. We assessed body fat percentage (dual-energy X-ray absorptiometry), body mass index, waist circumference, systolic and diastolic blood pressure, glucose, insulin, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, ALT, GGT, and high-sensitivity C-reactive protein (hsCRP) and calculated a continuous metabolic syndrome score variable. We also used factor analysis to examine whether high-normal liver enzymes are a feature of metabolic syndrome among children.


RESULTS
Children with overweight or obesity, defined by International Obesity Task Force (IOTF) criteria, had a 2.1-times higher risk of having ALT and a 4.5-times higher risk of having GGT in the highest fifth of its distribution than normal weight children. Children in the highest sex-specific third of metabolic syndrome score, body fat percentage, waist circumference, and insulin had a two to three times higher risk of being in the highest fifth of ALT and GGT. Moreover, children in the highest third of glucose and hsCRP had a 2.5-fold risk of being in the highest fifth of GGT. First-order factor analysis yielded three factors; the first included insulin, glucose, and triglycerides; the second waist circumference, insulin, GGT, and hsCRP; and the third HDL-C, triglycerides, waist circumference, and insulin. Second-order factor analysis yielded a single metabolic syndrome factor, explaining 64.1% of the variance.


CONCLUSIONS
Clustering of metabolic risk factors, particularly excess body fat, is associated with high-normal levels of ALT and GGT in prepubertal children. High-normal levels of liver enzymes, especially GGT, and systemic low-grade inflammation could be considered features of metabolic syndrome among children. Subtle changes in liver function may play an important role in the pathogenesis of metabolic syndrome beginning in childhood.
Department of Physiology, Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, Kuopio, Finland.
Anna
A
Viitasalo
David E
DE
Laaksonen
Virpi
V
Lindi
Aino-Maija
AM
Eloranta
Jarmo
J
Jääskeläinen
Tuomo
T
Tompuri
Sari
S
Väisänen
Hanna-Maaria
HM
Lakka
Timo A
TA
Lakka
D017668:Age of Onset; D001823:Body Composition / Q000502:physiology; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D016000:Cluster Analysis; D004035:Diet Therapy; D004798:Enzymes / Q000097:blood*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology*; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D009043:Motor Activity / Q000502:physiology; D009765:Obesity / Q000097:blood / Q000150:complications / Q000453:epidemiology; D050177:Overweight / Q000097:blood / Q000150:complications / Q000453:epidemiology; D012307:Risk Factors
D004798:Enzymes