Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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Serum alanine aminotransferase levels are closely associated with metabolic disturbances in apparently healthy young adolescents independent of obesity

  • Kim, Ki Eun (Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine) ;
  • Baek, Kyung Suk (Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine) ;
  • Han, Sol (Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine) ;
  • Kim, Jung Hyun (Atmin Radiology and Health Promotion Center) ;
  • Shin, Youn Ho (Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine)
  • 투고 : 2018.05.05
  • 심사 : 2018.09.04
  • 발행 : 2019.02.15
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초록

Purpose: Liver metabolism plays a pivotal role in the development of metabolic disorders. We aimed to investigate the clinical and laboratory risk factors associated with alanine aminotransferase (ALT) levels in young adolescents from an urban population in Korea. Methods: A population of 120 apparently healthy adolescents aged 12-13 years was included in the cross-sectional design study; 58 were overweight or obese and 62 were of normal weight. We estimated anthropometric and laboratory measurements, including waist-to-height ratio, blood pressure, insulin sensitivity, aspartate aminotransferases (AST), ALT, and lipid profiles. Results: The mean ages of the overweight or obese and normal weight participants were $12.9{\pm}0.3$ and $13.0{\pm}0.3years$, respectively. Height, weight, body mass index, waist circumference, waist-to-height ratio, systolic and diastolic blood pressure, AST, ALT, total cholesterol, low-density lipoprotein-cholesterol, triglyceride, insulin, and the homeostatic model assessment of insulin resistance (HOMA-IR) score were significantly higher and the high-density lipoprotein-cholesterol and quantitative insulin-sensitivity check index were significantly lower in the overweight/obese participants in comparison to the normal-weight participants (all P<0.05). In multivariate linear regression analysis, waist-to-height ratio, systolic blood pressure, and HOMA-IR score were independently and positively associated with serum ALT levels. Conclusion: Screening for ALT levels in adolescents may help to differentiate those at risk of metabolic abnormalities and thus prevent disease progression at an early age.

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참고문헌

  1. Huffman MD, Capewell S, Ning H, Shay CM, Ford ES, Lloyd-Jones DM. Cardiovascular health behavior and health factor changes (1988-2008) and projections to 2020: results from the National Health and Nutrition Examination Surveys. Circulation 2012;125:2595-602. https://doi.org/10.1161/CIRCULATIONAHA.111.070722
  2. Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes (Lond) 2011;35:891-8. https://doi.org/10.1038/ijo.2010.222
  3. Schwimmer JB, McGreal N, Deutsch R, Finegold MJ, Lavine JE. Influence of gender, race, and ethnicity on suspected fatty liver in obese adolescents. Pediatrics 2005;115:e561-5. https://doi.org/10.1542/peds.2004-1832
  4. Lavine JE, Schwimmer JB. Nonalcoholic fatty liver disease in the pediatric population. Clin Liver Dis 2004;8:549-58, viii-ix. https://doi.org/10.1016/j.cld.2004.04.010
  5. Kodhelaj K, Resuli B, Petrela E, Malaj V, Jaze H. Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in Albanian overweight children. Minerva Pediatr 2014;66:23-30.
  6. Brunt EM. Pathology of nonalcoholic fatty liver disease. Nat Rev Gastroenterol Hepatol 2010;7:195-203. https://doi.org/10.1038/nrgastro.2010.21
  7. Takahashi Y, Fukusato T. Pediatric nonalcoholic fatty liver disease: overview with emphasis on histology. World J Gastroenterol 2010;16:5280-5. https://doi.org/10.3748/wjg.v16.i42.5280
  8. Park HK, Hwang JS, Moon JS, Lee JA, Kim DH, Lim JS. Healthy range of serum alanine aminotransferase and its predictive power for cardiovascular risk in children and adolescents. J Pediatr Gastroenterol Nutr 2013;56:686-91. https://doi.org/10.1097/MPG.0b013e31828b4e67
  9. Park JH, Kim SH, Park S, Park MJ. Alanine aminotransferase and metabolic syndrome in adolescents: the Korean National Health and Nutrition Examination Survey Study. Pediatr Obes 2014;9:411-8. https://doi.org/10.1111/j.2047-6310.2013.00199.x
  10. Park SH, Heo NY, Park JH, Kim TO, Yang SY, Moon YS, et al. Obesity, insulin resistance, and the risk of an elevated alanine aminotransferase activity in the Korean adolescent population. J Pediatr Endocrinol Metab 2012;25:945-9.
  11. Suzuki D, Hashimoto E, Kaneda K, Tokushige K, Shiratori K. Liver failure caused by non-alcoholic steatohepatitis in an obese young male. J Gastroenterol Hepatol 2005;20:327-9. https://doi.org/10.1111/j.1440-1746.2005.03724.x
  12. Kim YS, Um SH, Ryu HS, Lee JB, Lee JW, Park DK, et al. The prognosis of liver cirrhosis in recent years in Korea. J Korean Med Sci 2003;18:833-41. https://doi.org/10.3346/jkms.2003.18.6.833
  13. Schwimmer JB, Behling C, Newbury R, Deutsch R, Nievergelt C, Schork NJ, et al. Histopathology of pediatric nonalcoholic fatty liver disease. Hepatology 2005;42:641-9. https://doi.org/10.1002/hep.20842
  14. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2095-128. https://doi.org/10.1016/S0140-6736(12)61728-0
  15. Kim JH, Yun S, Hwang SS, Shim JO, Chae HW, Lee YJ, et al. The 2017 Korean National Growth Charts for children and adolescents: development, improvement, and prospects. Korean J Pediatr 2018;61:135-49. https://doi.org/10.3345/kjp.2018.61.5.135
  16. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-9. https://doi.org/10.1007/BF00280883
  17. Purcell M, Flores YN, Zhang ZF, Denova-Gutierrez E, Salmeron J. Prevalence and predictors of alanine aminotransferase elevation among normal weight, overweight and obese youth in Mexico. J Dig Dis 2013;14:491-9. https://doi.org/10.1111/1751-2980.12072
  18. Fraser A, Longnecker MP, Lawlor DA. Prevalence of elevated alanine aminotransferase among US adolescents and associated factors: NHANES 1999-2004. Gastroenterology 2007;133:1814-20. https://doi.org/10.1053/j.gastro.2007.08.077
  19. Lee Y, Han KD, Jung JJ, Lee KH, Cho KH, Kim YH. Upper normal alanine aminotransferase range and insulin resistance in Korean adolescents: Korean National Health and Nutrition Examination Survey, 2009-2010. Dig Dis Sci 2016;61:1700-6. https://doi.org/10.1007/s10620-015-4009-x
  20. Sookoian S, Pirola CJ. Alanine and aspartate aminotransferase and glutamine-cycling pathway: their roles in pathogenesis of metabolic syndrome. World J Gastroenterol 2012;18:3775-81. https://doi.org/10.3748/wjg.v18.i29.3775
  21. Goessling W, Massaro JM, Vasan RS, D'Agostino RB Sr, Ellison RC, Fox CS. Aminotransferase levels and 20-year risk of metabolic syndrome, diabetes, and cardiovascular disease. Gastroenterology 2008;135:1935-44, 1944.e1. https://doi.org/10.1053/j.gastro.2008.09.018
  22. Gonzalez-Gil EM, Bueno-Lozano G, Bueno-Lozano O, Moreno LA, Cuadron-Andres L, Huerta-Blas P, et al. Serum transaminases concentrations in obese children and adolescents. J Physiol Biochem 2009;65:51-9. https://doi.org/10.1007/BF03165969
  23. Calcaterra V, Muratori T, Klersy C, Albertini R, Caramagna C, Brizzi V, et al. Early-onset metabolic syndrome in prepubertal obese children and the possible role of alanine aminotransferase as marker of metabolic syndrome. Ann Nutr Metab 2011;58:307-14. https://doi.org/10.1159/000331573
  24. Rasouli N, Molavi B, Elbein SC, Kern PA. Ectopic fat accumulation and metabolic syndrome. Diabetes Obes Metab 2007;9:1-10.
  25. Ali AT, Ferris WF, Naran NH, Crowther NJ. Insulin resistance in the control of body fat distribution: a new hypothesis. Horm Metab Res 2011;43:77-80. https://doi.org/10.1055/s-0030-1269851
  26. Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr 2005;56:303-7. https://doi.org/10.1080/09637480500195066
  27. Nambiar S, Truby H, Davies PS, Baxter K. Use of the waist-height ratio to predict metabolic syndrome in obese children and adolescents. J Paediatr Child Health 2013;49:E281-7. https://doi.org/10.1111/jpc.12147
  28. Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A, Silikiotou N, et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord 2000;24:1453-8. https://doi.org/10.1038/sj.ijo.0801401
  29. Weili Y, He B, Yao H, Dai J, Cui J, Ge D, et al. Waist-to-height ratio is an accurate and easier index for evaluating obesity in children and adolescents. Obesity (Silver Spring) 2007;15:748-52. https://doi.org/10.1038/oby.2007.601
  30. Kuba VM, Leone C, Damiani D. Is waist-to-height ratio a useful indicator of cardio-metabolic risk in 6-10-year-old children? BMC Pediatr 2013;13:91. https://doi.org/10.1186/1471-2431-13-91
  31. de Padua Cintra I, Zanetti Passos MA, Dos Santos LC, da Costa Machado H, Fisberg M. Waist-to-height ratio percentiles and cutoffs for obesity: a cross-sectional study in brazilian adolescents. J Health Popul Nutr 2014;32:411-9.
  32. Mokha JS, Srinivasan SR, Dasmahapatra P, Fernandez C, Chen W, Xu J, et al. Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: the Bogalusa Heart Study. BMC Pediatr 2010;10:73. https://doi.org/10.1186/1471-2431-10-73
  33. Khoury M, Manlhiot C, McCrindle BW. Role of the waist/height ratio in the cardiometabolic risk assessment of children classified by body mass index. J Am Coll Cardiol 2013;62:742-51. https://doi.org/10.1016/j.jacc.2013.01.026
  34. Committee on Adolescent Health Care Services and Models of Care for Treatment, Prevention, and Healthy Development; Board on Children, Youth, and Families; Division of Behavioral and Social Sciences and Education. Challenges in adolescent health care. Workshop Report. Washington, DC: National Academies Press, 2007.
  35. Quiros-Tejeira RE, Rivera CA, Ziba TT, Mehta N, Smith CW, Butte NF. Risk for nonalcoholic fatty liver disease in Hispanic youth with BMI > or =95th percentile. J Pediatr Gastroenterol Nutr 2007;44:228-36. https://doi.org/10.1097/MPG.0b013e31802d4acc

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