title: Hepatic steatosis and severity-related factors in obese children.
abstract: OBJECTIVE
  Obesity is an important health-care problem in developed countries. It is considered a multisystemic disease, but it may also affect the liver, thus provoking non-alcoholic fatty liver disease. This disease has been less extensively studied among children than among adults. We propose to analyze the prevalence of hepatic steatosis among a pediatric population within an area in southern Europe besides the variables associated with its development and severity.
  
  
  METHODS
  Cross-sectional study carried out on a population of children aged 6-14 years inclusive, using abdominal ultrasound as a method to determine the presence and severity of hepatic steatosis; in addition, anthropometric and blood-tested parameters were examined to determine which of these were associated with steatosis.
  
  
  RESULTS
  One hundred forty-four children were analyzed, 84 male (58.3%). Steatosis was detected in 50 children (34.7%; 95% confidence interval [CI]: 26.0-42.0%). In six of these cases (12%), elevated aminotransferase levels were recorded. Factors found to be associated with steatosis were body mass index ≥ 99th percentile (odds ratio [OR] 3.58, 95% CI 1.16-15.6) and the level of alanine aminotransferase (ALT) (OR 1.08, 95% CI 1.03-1.13), while its severity was associated with ALT (OR 1.17, 95% CI 1.09-1.28). A level of ALT < 23.5 UI/dL predicted lack of severe steatosis with an area under receiver operating characteristic curve of 0.805 (95% CI 0.683-0.927).
  
  
  CONCLUSIONS
  Non-alcoholic fatty liver disease is common in the obese pediatric population in our geographical area. High levels of ALT are associated with severe steatosis, although having ALT above the normal range is not common. Also, the lack of severity of steatosis can be predicted in a subgroup of children with obesity.
authors.affiliation: Gastroenterology Unit, Costa del Sol Sanitary Agency; Research Unit, Research Network of Health Services in Chronic Diseases-REDISSEC, Marbella.
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Navarro-Jarabo
authors.forename: Esther
authors.initials: E
authors.lastname: Ubiña-Aznar
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Tapia-Ceballos
authors.forename: Carmen
authors.initials: C
authors.lastname: Ortiz-Cuevas
authors.forename: M Angeles
authors.initials: MA
authors.lastname: Pérez-Aísa
authors.forename: Francisco
authors.initials: F
authors.lastname: Rivas-Ruiz
authors.forename: Raul J
authors.initials: RJ
authors.lastname: Andrade
authors.forename: Emilio
authors.initials: E
authors.lastname: Perea-Milla
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002648:Child; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D015588:Observer Variation; D015995:Prevalence; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D000637:Transaminases / Q000097:blood
chemical_list: D015415:Biomarkers; D000637:Transaminases
keywords: aminotransferase levels; children; hepatic disease; non-alcoholic fatty liver disease; obesity; severity disease; steatosis