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Nonalcoholic Fatty Liver Disease and Carotid Atherosclerosis in Children Lucia Pacifico, Vito Cantisani, Paolo Ricci, John F. Osborn, Elisa Schiavo, Caterina Anania, Eva Ferrara, Giuliano Dvisic, and Claudio Chiesa Departments of Pediatrics, Radiology, and Public Health Sciences, La Sapienza University of Rome; National Research Council, Rome, Italy Pacifico L, et al. Pediatr Res 2008; vol. 63, April issue. Epud ahead of print January 24, 2008
Background ,[object Object],Its presence could signify a substantial cardiovascular risk above and beyond that conferred by individual risk factors   
[object Object],OBJECTIVE  The aims of our study were to determine the presence of subclinical atherosclerosis (measured as carotid intima-media thickness,IMT) in obese children with and without NAFLD, and to evaluate correlates of carotid IMT
SUBJECTS ,[object Object],CASES: Children with primary obesity CONTROLS: Healthy children   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MATERIALS AND METHODS ,[object Object],[object Object],[object Object],[object Object],[object Object]
MATERIALS AND METHODS ,[object Object],[object Object],[object Object],[object Object]
RESULTS   Values are means (95% confidence intervals) <0.0001 <0.0001 <0.0001 <0.0001 0.16 0.50 0.89 P 69 ( 68-70) 73 (72-74)  Diastolic BP  mmHg 106 (104-108) 115 (109-120)  Systolic BP  mmHg -0.04 (-0.39-0.29) 1.92 (1.78-2.07)  SD score-BMI 17.5 (16.6-18.4) 24.7 (23.8-25.7)  BMI- kg/m 2 10 (33.3) 17 (27.4) Prepubertal stage: 14 (46.6) 34 (54.8) Gender  – Male (%) 10.1 (8.8-11.3) 10.0 (9.4-10.7) Age  - years Controls Obese children
RESULTS   Values are geometric means (95% confidence intervals) <0.01 17 (15-19) 35 (28-42) ALT <0.0001 <0.0001 <0.01 <0.01 <0.0001 0.51 <0.05 0.67 <0.01 P 75 (65-87) 105 (90-123) Triglycerides  mg/dL 144 (131-157) 146 (123-162) Total cholesterol  mg/dL 0.39 (0.35-0.43) 0.49 (0.46-0.52) Mean IMT mm 0.40 (0.36-0.43) 0.53 (0.50-0.56) Maximum IMT mm 1.8 (1.5-2.1) 3 (2.4-3.7) HOMA-IR  8.2 (7.0-9.6) 13.7 (11.2-16.7) Insulin  μ U/mL 6 (4.8-7.5) 17 (14.6-20) Leptin  ng/dL 12.2 (10.0-14.9) 11 (9.6-12.8) Adiponectin  ng/mL 42 (40-45) 38 (36-40) HDL  mg/dL Controls Obese children
RESULTS Obese children 46,7% Values are means (95% confidence intervals) The diagnosis of NAFLD was based on ultrasoun scan   0.09 <0.01 0.81 0.24 0.90 0.56 0.59 P 110 (108-113) 115 (112-118) Systolic BP  mmHg 72 (71-74) 74 (72-76) Diastolic BP  mmHg 10 (9.0-11.0)) 10.4 (9.5-11.4) Age  - years 19 (57.5) 15 (51.7) Gender  – Male (%) 10 (30.3) 7 (24.1) Prepubertal stage 24.3 (23.0-25.6) 25.4 (24.2-26.5) BMI- kg/m 2 1.91 (1.67-2.15) 1.95 (1.82-2.07) SD score-BMI no NAFLD NAFLD
RESULTS Obese children 46,7% Values are geometric means (95% confidence intervals) <0.01 <0.01 <0.05 0.43 <0.05 <0.05 0.31 0.28 0.48 <0.0001 P 22 (18-27) 52 (39-65) ALT 99 (75-130) 108 (91-134) Triglycerides  mg/dL 125 (93-167) 152 (132–174) Total cholesterol  mg/dL 39 (37-42) 37 (34-40) HDL  mg/dL 0.45 (0.42–0.48) 0.54 (0.50–0.58)  Mean IMT  m. 0.49 (0.46-0.52) 0.58 (0.54–0.62)  Maximum IMT  m. 12.7 (10.6–15.1) 9.3 (7.4–11.7)  Adiponectin  ng/mL 16.1 (12.9–20.2) 18.3 (14.4–23.4) Leptin  ng/mL 2.5 (1.9–3.3) 4 (2.8–5.5)  HOMA-IR 11 (8.8–14.7) 17.3 (12.6-23.7)  Insulin   μ U/mL no NAFLD NAFLD
RESULTS   Variables independently associated with carotid IMT in obese children:  *  Results of a stepwise linear regression analysis started with the following independent variables: age, gender, pubertal stage, BMI, fat mass, systolic and diastolic BP, total and HDL cholesterol, triglycerides, HOMA-IR values, adiponectin and leptin levels. <0.01 <0.0001 P 1.022-1.084 1.041-1.119 95% CI  for e b e b Coefficient,  b  Independent variable 1.083 0.080 Fatty liver severity score 1.053 0.053  Tanner stage Stepwise regression analysis*
CONCLUSIONS ,[object Object],[object Object],[object Object],[object Object]

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Nonalcoholic fatty liver disease and carotid atherosclerosis in children

  • 1. Nonalcoholic Fatty Liver Disease and Carotid Atherosclerosis in Children Lucia Pacifico, Vito Cantisani, Paolo Ricci, John F. Osborn, Elisa Schiavo, Caterina Anania, Eva Ferrara, Giuliano Dvisic, and Claudio Chiesa Departments of Pediatrics, Radiology, and Public Health Sciences, La Sapienza University of Rome; National Research Council, Rome, Italy Pacifico L, et al. Pediatr Res 2008; vol. 63, April issue. Epud ahead of print January 24, 2008
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  • 7. RESULTS Values are means (95% confidence intervals) <0.0001 <0.0001 <0.0001 <0.0001 0.16 0.50 0.89 P 69 ( 68-70) 73 (72-74) Diastolic BP mmHg 106 (104-108) 115 (109-120) Systolic BP mmHg -0.04 (-0.39-0.29) 1.92 (1.78-2.07) SD score-BMI 17.5 (16.6-18.4) 24.7 (23.8-25.7) BMI- kg/m 2 10 (33.3) 17 (27.4) Prepubertal stage: 14 (46.6) 34 (54.8) Gender – Male (%) 10.1 (8.8-11.3) 10.0 (9.4-10.7) Age - years Controls Obese children
  • 8. RESULTS Values are geometric means (95% confidence intervals) <0.01 17 (15-19) 35 (28-42) ALT <0.0001 <0.0001 <0.01 <0.01 <0.0001 0.51 <0.05 0.67 <0.01 P 75 (65-87) 105 (90-123) Triglycerides mg/dL 144 (131-157) 146 (123-162) Total cholesterol mg/dL 0.39 (0.35-0.43) 0.49 (0.46-0.52) Mean IMT mm 0.40 (0.36-0.43) 0.53 (0.50-0.56) Maximum IMT mm 1.8 (1.5-2.1) 3 (2.4-3.7) HOMA-IR 8.2 (7.0-9.6) 13.7 (11.2-16.7) Insulin μ U/mL 6 (4.8-7.5) 17 (14.6-20) Leptin ng/dL 12.2 (10.0-14.9) 11 (9.6-12.8) Adiponectin ng/mL 42 (40-45) 38 (36-40) HDL mg/dL Controls Obese children
  • 9. RESULTS Obese children 46,7% Values are means (95% confidence intervals) The diagnosis of NAFLD was based on ultrasoun scan 0.09 <0.01 0.81 0.24 0.90 0.56 0.59 P 110 (108-113) 115 (112-118) Systolic BP mmHg 72 (71-74) 74 (72-76) Diastolic BP mmHg 10 (9.0-11.0)) 10.4 (9.5-11.4) Age - years 19 (57.5) 15 (51.7) Gender – Male (%) 10 (30.3) 7 (24.1) Prepubertal stage 24.3 (23.0-25.6) 25.4 (24.2-26.5) BMI- kg/m 2 1.91 (1.67-2.15) 1.95 (1.82-2.07) SD score-BMI no NAFLD NAFLD
  • 10. RESULTS Obese children 46,7% Values are geometric means (95% confidence intervals) <0.01 <0.01 <0.05 0.43 <0.05 <0.05 0.31 0.28 0.48 <0.0001 P 22 (18-27) 52 (39-65) ALT 99 (75-130) 108 (91-134) Triglycerides mg/dL 125 (93-167) 152 (132–174) Total cholesterol mg/dL 39 (37-42) 37 (34-40) HDL mg/dL 0.45 (0.42–0.48) 0.54 (0.50–0.58) Mean IMT m. 0.49 (0.46-0.52) 0.58 (0.54–0.62) Maximum IMT m. 12.7 (10.6–15.1) 9.3 (7.4–11.7) Adiponectin ng/mL 16.1 (12.9–20.2) 18.3 (14.4–23.4) Leptin ng/mL 2.5 (1.9–3.3) 4 (2.8–5.5) HOMA-IR 11 (8.8–14.7) 17.3 (12.6-23.7) Insulin μ U/mL no NAFLD NAFLD
  • 11. RESULTS Variables independently associated with carotid IMT in obese children: * Results of a stepwise linear regression analysis started with the following independent variables: age, gender, pubertal stage, BMI, fat mass, systolic and diastolic BP, total and HDL cholesterol, triglycerides, HOMA-IR values, adiponectin and leptin levels. <0.01 <0.0001 P 1.022-1.084 1.041-1.119 95% CI for e b e b Coefficient, b Independent variable 1.083 0.080 Fatty liver severity score 1.053 0.053 Tanner stage Stepwise regression analysis*
  • 12.