Clinical and laboratory characteristics and elastography results in children with obesity and metabolic fatty liver disease

Abstract

Introduction. To date, the obesity pandemic is closely linked to the spread of metabolic-associated fatty liver disease (MAFLD), the detection rate of which among children tends to increase. Purpose of the study: to determine the frequency of MAFLD in children with various types of obesity, evaluating metabolic status and liver parenchyma rigidity. Material and methods: this work is based on the results of a prospective study of 66 children with obesity aged 12-18 years, as well as 30 children with normal body weight. Anthropometric studies, biochemical studies to determine the levels of aminotransferases, bilirubin, alkaline phosphatase, and gamma-glutamyltransferase, and enzyme-linked immunosorbent assays to determine leptin and interleukins were conducted. Ultrasound examination of the abdominal organs and liver elastography were performed. The results of the conducted study indicate a high prevalence of MAFLD among children with exogenous-constitutional obesity, especially in its abdominal type. The obtained data align with modern concepts regarding the leading role of visceral obesity in the development of metabolic disorders and liver damage. The frequency of MAFLD in children with abdominal obesity was 57.14%, which was 2 times higher than the same indicator in children with uniform fat distribution (29.03%), confirming a higher risk of liver steatosis formation in cases of visceral fat accumulation. The study of biochemical indicators demonstrated the presence of functional liver changes in children with obesity. Despite the fact that the average values of transaminases were within the reference intervals, the levels of ALT and AST in children with abdominal obesity were significantly higher compared to both children with uniform obesity and the control group An increase in ALT of more than 1.5 times was primarily identified in children with abdominal obesity, which may indicate the formation of inflammatory changes in the liver and the development of metabolically associated steatohepatitis. It has been established that liver tissue stiffness indicators were significantly higher in children with obesity compared to healthy children, with maximum values observed in the combination of abdominal obesity and MAFLD. In children with abdominal obesity and MAFLD, the highest levels of leptin, TNF-α, and IL-6 were identified. An increase in leptin concentration reflects the development of visceral fat tissue dysfunction and the formation of leptin resistance. Simultaneously, an increase in TNF-α and IL-6 levels indicates the activation of chronic low-intensity inflammation. Conclusion. Thus, the research results confirm the multifactorial nature of MAFLD development in children and demonstrate a close correlation between abdominal obesity, inflammatory changes, impaired adipokin secretion, and early signs of liver tissue remodeling.