title: Enhanced liver fibrosis (ELF) test in obese children with ultrasound-proven liver steatosis.
abstract: OBJECTIVE
  Non-alcoholic fatty liver disease (NAFLD) in obese children is a diagnostic challenge. The enhanced liver fibrosis test (ELF) based on the combination of serum concentration of hyaluronic acid (HA), aminoterminal propeptide of type III procollagen (PIIINP), tissue inhibitor of matrix metalloproteinase type 1 (TIMP-1) was developed as a noninvasive diagnostic tool for estimation of degree of liver fibrosis. The aim of our study was to investigate the performance of ELF test in obese children with ultrasound-proven steatosis in order assess the possibility of early detection of fibrotic changes in liver structure.
  
  
  METHODS
  58 obese (BMI >95th percentile) children, 27 male (mean age 13.9±2.65 years) and 31 female (mean age 13.82±2.64 years). Based on the liver ultrasound (US) examination results two groups of obese children were studied: group with steatosis (N=20, 8/12 M/F, mean age 14.2±1.90 years, BMI 32.9±5.60 kg/m2) and group with normal liver US (n=38, 19/19 M/F, mean age 13.7±2.94 years, BMI 30.4±4.67 kg/m2). Serum activity of aminotransferases (AST, ALT) and lactate dehydrogenase (LDH), and γ-glutamyl transpeptidase (GGT), and ELF test (HA, PIIINP, and TIMP-1 were analyzed.
  
  
  RESULTS
  Children with liver steatosis presented with significantly higher AST (34.1 vs. 25.6 U/L), ALT (43.4 vs. 32 U/L), LDH (427.5 vs. 361.3 U/L), GGT (30.7 vs. 18.9 U/L). The ELF test value was also significantly higher in that group (8.98 vs. 8.49). Nevertheless no combination of measured parameters with ELF test value show better diagnostic value for differentiation between children with and without steaotosis.
  
  
  CONCLUSIONS
  ELF test cannot be used for assessment of steatosis in obese children.
authors: Department of Clinical Biochemistry, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
authors: Patrycja
authors: P
authors: Szybowska
authors: Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
authors: Malgorzata
authors: M
authors: Wojcik
authors: Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
authors: Jerzy B
authors: JB
authors: Starzyk
authors: Department of Clinical Biochemistry, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
authors: Krystyna
authors: K
authors: Sztefko