Roberto Massao Yamada

Indicadores bioquímicos, antropométricos e de composição corporal como preditores da esteatose hepática em adolescentes obesos

OBJECTIVE: To describe the prevalence of hepatic steatosis and to assess the performance of biochemical, anthropometric and body composition indicators for hepatic steatosis in obese teenagers. METHODS: Cross-sectional study including 79 adolecents aged from ten to 18 years old. Hepatic steatosis was diagnosed by abdominal ultrasound in case of moderate or intense hepatorenal contrast and/or a difference in the histogram ≥7 on the right kidney cortex. The insulin resistance was determined by the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) index for values >3.16. Anthropometric and body composition indicators consisted of body mass index, body fat percentage, abdominal circumference and subcutaneous fat. Fasting glycemia and insulin, lipid profile and hepatic enzymes, such as aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase and alkaline phosphatase, were also evaluated. In order to assess the performance of these indicators in the diagnosis of hepatic steatosis in teenagers, a ROC curve analysis was applied. RESULTS: Hepatic steatosis was found in 20% of the patients and insulin resistance, in 29%. Gamma-glutamyltransferase and HOMA-IR were good indicators for predicting hepatic steatosis, with a cutoff of 1.06 times above the reference value for gamma-glutamyltransferase and 3.28 times for the HOMA-IR. The anthropometric indicators, the body fat percentage, the lipid profile, the glycemia and the aspartate aminotransferase did not present significant associations. CONCLUSIONS: Patients with high gamma-glutamyltransferase level and/or HOMA-IR should be submitted to abdominal ultrasound examination due to the increased chance of having hepatic steatosis.OBJETIVO:Descrever a prevalencia da esteatose hepatica e avaliar o desempenho de indicadores bioquimicos, antropometricos e de composicao corporal para identificar a doenca em adolescentes obesos.METODOS: Estudo transversal com 79 adolescentes de dez a 18 anos. Diagnosticou-se a esteatose hepatica por ultrassom abdominal em caso de contraste hepatorrenal moderado ou intenso e/ou diferenca no histograma ≥7 em relacao ao cortex do rim direito. Determinou-se a resistencia a insulina pelo indice Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) para valores >3,16. Os indicadores antropometricos e de composicao corporal foram: indice de massa corporea, porcentagem de gordura corporal, circunferencia abdominal e gordura subcutânea. Dosaram-se glicemia e insulina de jejum, perfil lipidico e enzimas hepaticas aspartato aminotransferase, alanina aminotransferase, gama-glutamiltransferase e fosfatase alcalina. Aplicou-se a curva ROC para avaliar o desempenho dos indicadores para identificar adolescentes com esteatose hepatica.RESULTADOS:A esteatose hepatica esteve presente em 20% dos pacientes e a resistencia a insulina, em 29%. A gama-glutamiltransferase e o HOMA-IR mostraram-se bons indicadores para predizer a esteatose hepatica, com ponto de corte de 1,06 vezes acima do valor de referencia para a gama-glutamiltransferase e de 3,28 para o HOMA-IR. Os indicadores antropometricos, a porcentagem de gordura corporal, o perfil lipidico, a glicemia e a aspartato aminotransferase nao apresentaram diferencas significantes.CONCLUSOES: Pacientes com elevacao de gama-glutamiltransferase e/ou HOMA-IR devem ser submetidos ao exame de ultrassom abdominal, havendo grande probabilidade de se obter como resultado a esteatose hepatica.

Biochemical, anthropometric and body composition indicators as predictors of hepatic steatosis in obese adolescents

OBJECTIVE: To describe the prevalence of hepatic steatosis and to assess the performance of biochemical, anthropometric and body composition indicators for hepatic steatosis in obese teenagers. METHODS: Cross-sectional study including 79 adolecents aged from ten to 18 years old. Hepatic steatosis was diagnosed by abdominal ultrasound in case of moderate or intense hepatorenal contrast and/or a difference in the histogram ≥7 on the right kidney cortex. The insulin resistance was determined by the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) index for values >3.16. Anthropometric and body composition indicators consisted of body mass index, body fat percentage, abdominal circumference and subcutaneous fat. Fasting glycemia and insulin, lipid profile and hepatic enzymes, such as aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase and alkaline phosphatase, were also evaluated. In order to assess the performance of these indicators in the diagnosis of hepatic steatosis in teenagers, a ROC curve analysis was applied. RESULTS: Hepatic steatosis was found in 20% of the patients and insulin resistance, in 29%. Gamma-glutamyltransferase and HOMA-IR were good indicators for predicting hepatic steatosis, with a cutoff of 1.06 times above the reference value for gamma-glutamyltransferase and 3.28 times for the HOMA-IR. The anthropometric indicators, the body fat percentage, the lipid profile, the glycemia and the aspartate aminotransferase did not present significant associations. CONCLUSIONS: Patients with high gamma-glutamyltransferase level and/or HOMA-IR should be submitted to abdominal ultrasound examination due to the increased chance of having hepatic steatosis.OBJETIVO:Descrever a prevalencia da esteatose hepatica e avaliar o desempenho de indicadores bioquimicos, antropometricos e de composicao corporal para identificar a doenca em adolescentes obesos.METODOS: Estudo transversal com 79 adolescentes de dez a 18 anos. Diagnosticou-se a esteatose hepatica por ultrassom abdominal em caso de contraste hepatorrenal moderado ou intenso e/ou diferenca no histograma ≥7 em relacao ao cortex do rim direito. Determinou-se a resistencia a insulina pelo indice Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) para valores >3,16. Os indicadores antropometricos e de composicao corporal foram: indice de massa corporea, porcentagem de gordura corporal, circunferencia abdominal e gordura subcutânea. Dosaram-se glicemia e insulina de jejum, perfil lipidico e enzimas hepaticas aspartato aminotransferase, alanina aminotransferase, gama-glutamiltransferase e fosfatase alcalina. Aplicou-se a curva ROC para avaliar o desempenho dos indicadores para identificar adolescentes com esteatose hepatica.RESULTADOS:A esteatose hepatica esteve presente em 20% dos pacientes e a resistencia a insulina, em 29%. A gama-glutamiltransferase e o HOMA-IR mostraram-se bons indicadores para predizer a esteatose hepatica, com ponto de corte de 1,06 vezes acima do valor de referencia para a gama-glutamiltransferase e de 3,28 para o HOMA-IR. Os indicadores antropometricos, a porcentagem de gordura corporal, o perfil lipidico, a glicemia e a aspartato aminotransferase nao apresentaram diferencas significantes.CONCLUSOES: Pacientes com elevacao de gama-glutamiltransferase e/ou HOMA-IR devem ser submetidos ao exame de ultrassom abdominal, havendo grande probabilidade de se obter como resultado a esteatose hepatica.

Indicadores bioquímicos, antropométricos y de composición corporal como predictores de la esteatosis hepática en adolescentes obesos

OBJECTIVE: To describe the prevalence of hepatic steatosis and to assess the performance of biochemical, anthropometric and body composition indicators for hepatic steatosis in obese teenagers. METHODS: Cross-sectional study including 79 adolecents aged from ten to 18 years old. Hepatic steatosis was diagnosed by abdominal ultrasound in case of moderate or intense hepatorenal contrast and/or a difference in the histogram ≥7 on the right kidney cortex. The insulin resistance was determined by the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) index for values >3.16. Anthropometric and body composition indicators consisted of body mass index, body fat percentage, abdominal circumference and subcutaneous fat. Fasting glycemia and insulin, lipid profile and hepatic enzymes, such as aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase and alkaline phosphatase, were also evaluated. In order to assess the performance of these indicators in the diagnosis of hepatic steatosis in teenagers, a ROC curve analysis was applied. RESULTS: Hepatic steatosis was found in 20% of the patients and insulin resistance, in 29%. Gamma-glutamyltransferase and HOMA-IR were good indicators for predicting hepatic steatosis, with a cutoff of 1.06 times above the reference value for gamma-glutamyltransferase and 3.28 times for the HOMA-IR. The anthropometric indicators, the body fat percentage, the lipid profile, the glycemia and the aspartate aminotransferase did not present significant associations. CONCLUSIONS: Patients with high gamma-glutamyltransferase level and/or HOMA-IR should be submitted to abdominal ultrasound examination due to the increased chance of having hepatic steatosis.OBJETIVO:Descrever a prevalencia da esteatose hepatica e avaliar o desempenho de indicadores bioquimicos, antropometricos e de composicao corporal para identificar a doenca em adolescentes obesos.METODOS: Estudo transversal com 79 adolescentes de dez a 18 anos. Diagnosticou-se a esteatose hepatica por ultrassom abdominal em caso de contraste hepatorrenal moderado ou intenso e/ou diferenca no histograma ≥7 em relacao ao cortex do rim direito. Determinou-se a resistencia a insulina pelo indice Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) para valores >3,16. Os indicadores antropometricos e de composicao corporal foram: indice de massa corporea, porcentagem de gordura corporal, circunferencia abdominal e gordura subcutânea. Dosaram-se glicemia e insulina de jejum, perfil lipidico e enzimas hepaticas aspartato aminotransferase, alanina aminotransferase, gama-glutamiltransferase e fosfatase alcalina. Aplicou-se a curva ROC para avaliar o desempenho dos indicadores para identificar adolescentes com esteatose hepatica.RESULTADOS:A esteatose hepatica esteve presente em 20% dos pacientes e a resistencia a insulina, em 29%. A gama-glutamiltransferase e o HOMA-IR mostraram-se bons indicadores para predizer a esteatose hepatica, com ponto de corte de 1,06 vezes acima do valor de referencia para a gama-glutamiltransferase e de 3,28 para o HOMA-IR. Os indicadores antropometricos, a porcentagem de gordura corporal, o perfil lipidico, a glicemia e a aspartato aminotransferase nao apresentaram diferencas significantes.CONCLUSOES: Pacientes com elevacao de gama-glutamiltransferase e/ou HOMA-IR devem ser submetidos ao exame de ultrassom abdominal, havendo grande probabilidade de se obter como resultado a esteatose hepatica.