State of the hepatobiliary system on the data of ultrasonic examination in children and adolescents with overweight and obesity

Abstract

Currently, a stable increase in the incidence of overweight and obesity is noted, this fact leads to an elevation in comorbidity with them. The relevance of the study is due to the involvement of the hepatobiliary system in the development of metabolic dysfunction and the formation of non-alcoholic fatty liver disease in the future.

The aim of the research was to study the effect of overweight and obesity in children and adolescents on the state of the hepatobiliary system on the basis of ultrasound examination.

Material and methods. A single-center retrospective comparative study was conducted. The main group consisted of 112 children and adolescents with Z-score body mass index (BMI) above +1SD, the comparison group consisted of 264 persons with a BMI from -2 to +1SD aged 5–17 years. An analysis of the results of anthropometric, including the assessment of BMI, ultrasound and biochemical studies was carried out.

Results. The Z-score of BMI corresponding to overweight was recorded in 54 (13.8%) examined persons, and obesity – in 58 (14.8%) patients. In children of the main group, an increase in the size of the liver was recorded 3.6 fold more often, diffuse changes in the liver were revealed 32.4 fold more often, an increase in the volume of the gallbladder – 2.1 fold, signs of excessive aerocolia – 3.3 fold more often (p<0.001). In children with overweight and obesity, the level of triglycerides (p=0.003), low-density lipoprotein cholesterol (p=0.035), glucose (p=0.012), C-reactive protein (p=0.011), malon dyalldehyde (p=0.012), the activity of alaninaminotransferase (p<0.001) and alkaline phosphatase (p=0.001) were statistically significant, with a significantly lower level of high-density lipoprotein cholesterol (p<0.001). Statistically significant logistic models of the probability of an increase in the linear dimensions of the liver, diffuse changes, an increase in the volume of the gallbladder, the presence of excessive aerocolia signs from the Z-score BMI value were obtained. The Nigelkirk determination coefficient was 0.34, 0.17, 0.11 and 0.10 c.u. respectively.

Conclusion. The contribution of overweight and obesity to the increase in the linear dimensions of the liver and the volume of the gallbladder, the formation of diffuse changes and excessive aerocolia according to the ultrasound examination was 10–34%.

Keywords:overweight; obesity; children and adolescents; hepatobiliary system; ultrasound examination

Contribution. Research concept and design, data collection and processing – Shtina I.E., Mamykina N.I.; statistical processing – Ivashova Yu.A., Shtina I.E., text writing – Shtina I.E., Ivashova Yu.A., Mamykina N.I.; editing of text – Ustinova O.Yu., Ivashova Yu.A.; the approval of the final version of the article, responsibility for the integrity of all parts of the article – all authors.

Funding. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

For citation: Shtina I.E., Ivashova Yu.A., Mamykina N.I., Ustinova O.Yu. State of the hepatobiliary system on the data of ultrasonic examination in children and adolescents with overweight and obesity. Voprosy pitaniia [Problems of Nutrition]. 2023; 92 (2): 60–70. DOI: https://doi.org/10.33029/0042-8833-2023-92-2-60-70 (in Russian)

References

1. WHO. Adolescent obesity and related behavior: Trends and inequalities in the WHO European Region, 2002–2014. URL: https://www.euro.who.int/__data/assets/pdf_file/0011/339626/WH05_obesity_Ebook.pdf

2. Statistical materials. The incidence of the child population of Russia (0–14 years) in 2019. Ministry of Health of the Russian Federation Department of monitoring, analysis and strategic development of health care of the Federal State Budgetary Institution «Central Research Institute for the Organization and Informatization of Health Care» of the Ministry of Health of Russia. Moscow, 2020: Pt V, VI. (in Russian)

3. Fedotova T.K., Gorbacheva A.K.Nutritional status of preschool children of moscow megalopolis at the beginning of the 21st century (somatometric aspects). Voprosy pitaniia [Problems of Nutrition]. 2021; 90 (6): 67–76. DOI: https://doi.org/10.33029/0042-8833-2021-90-6-67-76 (in Russian)

4. Golubev N.A., Ogryzko E.V., Shelepova E.A., Zalevskaya O.V. Morbidity of children by diseases of the endocrine system, itania’s diseases substance exchange within the national project of «Health» of the Russian Federation. Sovremennye problemy zdravookhraneniya i meditsinskoy statistiki [Modern Problems of Healthcare and Medical Statistics]. 2019; (3): 376–89. (in Russian)

5. Weihrauch-Blüher S., Schwarz P., Klusmann J.H. Childhood obesity: Increased risk for cardiometabolic disease and cancer in adulthood. Metabolism. 2019; 92: 147–52. DOI: https://doi.org/10.1016/j.metabol.2018.12.001

6. Sharafetdinov Kh.Kh, Plotnikova O.A. Obesity as a global challenge of the 21st century: clinical medical nutrition, prevention and therapy. Voprosy pitaniia [Problems of Nutrition]. 2020; 89 (4): 161–71. DOI: https://doi.org/10.24411/0042-8833-2020-10050 (in Russian)

7. DeBoer M.D. Assessing and managing the metabolic syndrome in children and adolescents. Nutrients. 2019; 11 (8): 1788. DOI: https://doi.org/10.3390/nu11081788

8. Ametov A.S., Prudnikova M.A. Nonalcoholic fatty liver disease and type 2 diabetes: the modern aspects of diagnosis and treatment. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2016; (3): 37–45. (in Russian)

9. Bokova T.A. Non-alcoholic fatty liver disease in children: relationship with the main components of metabolic syndrome in children. Eksperimental’naya i klinicheskaya gastoenterologiya [Experimental and Clinical Gastroenterology]. 2020; (1): 15–20. DOI: https://doi.org/10.31146/1682-8658-ecg-173-1-15-20 (in Russian)

10. Dvoryakovskaya G.M., Kutyreva E.N., Dvoryakovsky G.V., Strokova I.V., Ivleva S.A., Kaganov B.S. Ultrasound diagnostics of nonalcoholic fatty liver disease in children. Ul’trazvukovaya i funktsional’naya diagnostika [Ultrasound and Functional Diagnostics]. 2012; (4): 53–61. (in Russian)

11. Pavlovskaya E.V., Strokova T.V., Tin I.F., Zubovich A.I., Shavkina M.I. Nonalcoholic fatty liver disease in obese children: clinical characteristics, therapeutic options. Meditsinskiy opponent [Medical Opponent]. 2021; 4 (16): 46–52. (in Russian)

12. Kalashnikova V.A., Novikova V.P., Smirnova N.N. Noninvasive diagnostic method of nonalcoholic fatty liver disease in obese children. Eksperimental’naya i klinicheskaya gastoenterologiya [Experimental and Clinical Gastroenterology]. 2019; (8): 90–4. DOI: https://doi.org/10.31146/1682-8658-ecg-168-8-90-94 (in Russian)

13. Furman E.G., Koryukina I.P., Zarnitsyna N.Yu., Ponomareva M.S., Chistousova G.V., Akhmedov R.M. Non-alcoholic fatty liver disease with endocrine diseases in children and adolescents. Eksperimental’naya i klinicheskaya gastoenterologiya [Experimental and Clinical Gastroenterology]. 2018; (8): 35–40. DOI: https://doi.org/10.31146/1682-8658-ecg-156-8-35-40 (in Russian)

14. Mărginean C.O., Meliţ L.E., Ghiga D.V., Mărginean M.O. Early inflammatory status related to pediatric obesity. Front Pediatr. 2019; 7: 241. DOI: https://doi.org/10.3389/fped.2019.00241

15. Nobili V., Socha P. Pediatric nonalcoholic fatty liver disease: Current thinking. J Pediatr Gastroenterol Nutr. 2018; 66 (2): 188–92. DOI: https://doi.org/10.1097/MPG.0000000000001823

16. Peterkova V.A., Bezlepkina O.B., Bolotova N.V., Bogova E.A., Vasyukova O.V., Girsh Ya.V., et al. Clinical guidelines «Obesity in children». Problemy endokrinologii [Problems of Endocrinology]. 2021; 67 (5): 67–83. DOI: https://doi.org/10.14341/probl12802 (in Russian)

17. Vajro P., Lenta S., Socha P., Dhawan A., McKiernan P., Baumann U., et al. Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr. 2012; 54 (5): 700–13. DOI: https://doi.org/10.1097/MPG.0b013e318252a13f

18. Shannon A., Alkhouri N., Carter-Kent C., Monti L., Devito R., Lopez R., et al. Ultrasonographic quantitative estimation of hepatic steatosis in children with NAFLD. J Pediatr Gastroenterol Nutr. 2011; 53 (2): 190–5. DOI: https://doi.org/10.1097/MPG.0b013e31821b4b61

19. Dedov I.I., Mel’nichenko G.A. (eds). Endocrinology: National guidelines. 2nd ed., revised and additional. Moscow: GEOTAR-Media, 2019: 1112 p. (in Russian)

20. Dolgov V.V., Men’shikov V.V. Clinical laboratory diagnostics: national guide: in 2 vols. Moscow: GEOTAR-Media, 2012: (1): 928 p. (in Russian)

21. Encyclopedia of clinical laboratory tests. Eds by N.W. Tits; transl. from Engl. Moscow: UNIMED-press, 2003: 960 р. (in Russian)

22. Orekhovich V.N. (ed). Modern methods in biochemistry. Moscow: Meditsina, 1977: 392 р. (in Russian)

23. Dvoryakovsky I.V., Dvoryakovskaya G.M. (eds). Ultrasound diagnostics in neonatology and pediatrics: differential diagnostic criteria. Practical guide. 2nd ed., revised and additional. Moscow: Atmosfera, 2012: 172 p. (in Russian)

24. Martinchik A.N., Laykam K.E., Kozyreva N.A., Mikhaylov N.A., Keshabyants E.E., Baturin A.K., et al. Prevalence of overweight and obesity in children. Voprosy pitaniia [Problems of Nutrition]. 2022; 91 (3): 64–72. DOI: https://doi.org/10.33029/0042-8833-2022-91-3-64-72 (in Russian)

25. Netrebenko O.K., Ukraintsev S.E., Mel’nikova I.Yu. Obesity in children: new prevention concepts and approaches. Literature review. Voprosy sovremennoy pediatrii [Problems of Modern Pediatrics]. 2017; 16 (5): 399–405. DOI: https://doi.org/10.15690/vsp.v16i5.1804 (in Russian)

26. de F Rocha A.R., de S Morais N., Priore S.E., do Franceschini S.C.C. Inflammatory biomarkers and components of metabolic syndrome in adolescents: A systematic review. Inflammation. 2021; 45 (1): 14–30. DOI: https://doi.org/10.1007/s10753-021-01549-1

27. Povarova O.V., Gorodetskaya E.A., Kalenikova E.I., Medvedev O.S. Metabolic markers and oxidative stress in children’s obesity pathogenesis. Rossiyskiy vestnik perinatologii i pediatrii (Russian Bulletin of Perinatology and Pediatrics). 2020; 65 (1): 22–9. DOI: https://doi.org/10.21508/1027-4065-2020-65-1-22-29 (in Russian)

28. Povarova O.V., Gorodetskaya E.A., Kulyak O.Yu., Demyanenko A.N., Alimova I.L., Kalenikova E.I., et al. Substantiation of approaches to the correction of lipid metabolism disorders and non-alcoholic fatty liver disease in children with exogenous obesity. Ozhirenie i metabolism [Obesity and Metabolism]. 2022; 19 (1): 19–26. DOI: https://doi.org/10.14341/omet12802 (in Russian)

29. Bolotova N.V., Aver’yanov A.P., Zakharova N.B., Zotova Yu.A., Nikitina V.V., Stepanova T.V. The state of lipid peroxidation and antioxidant protection in obese children. Pediatriya. Zhurnal imeni G.N. Speranskogo [Pediatrics Journal named after G.N. Speransky]. 2006; 85 (4): 11–4. (in Russian)

30. Maevskaya M.V., Kotovskaya Y.V., Ivashkin V.T., Tkacheva O.N., Troshina E.A., et al. The National Consensus statement on the management of adult patients with non-alcoholic fatty liver disease and main comorbidities. Terapevticheskiy arkhiv [Therapeutic Archive]. 2022; 94 (2): 216–53. DOI: https://doi.org/10.26442/00403660.2022.02.201363 (in Russian)

31. Lazebnik L.B., Golovanova E.V., Turkina S.V., Raykhel’son K.L., Okovity S.V., et al. Non-alcoholic fatty liver disease in adults: clinic, diagnostics, treatment. Guidelines for therapists, third version. Eksperimental’naya i klinicheskaya gastoenterologiya [Experimental and Clinical Gastroenterology]. 2021; (1): 4–52. DOI: https://doi.org/10.31146/1682-8658-ecg-185-1-4-52 (in Russian)

32. Temple J.L., Cordero P., Li J., Nguyen V., Oben J.A. A guide to non-alcoholic fatty liver disease in childhood and adolescence. Int J Mol Sci. 2016; 17 (6): 947. DOI: https://doi.org/10.3390/ijms17060947

33. Anderson E.L., Howe L.D., Jones H.E., Higgins J.P., Lawlor D.A., Fraser A. The prevalence of non-alcoholic fatty liver disease in children and adolescents: A systematic review and meta-analysis. PLoS One. 2015; 10 (10): e0140908. DOI: https://doi.org/10.1371/journal.pone.0140908

34. D’Hondt A., Rubesova E., Xie H., Shamdasani V., Barth R.A. Liver fat quantification by ultrasound in children: A prospective study. AJR Am J Roentgenol. 2021; 217 (4): 996–1006. DOI: https://doi.org/10.2214/AJR.20.24874

35. Chiloiro M., Riezzo G., Chiarappa S., Correale M., Guerra V., Amati L., et al. Relationship among fatty liver, adipose tissue distribution and metabolic profile in moderately obese children: An ultrasonographic study. Curr Pharm Des. 2008; 14 (26): 2693–8. DOI: https://doi.org/10.2174/138161208786264197

36. Aleshina E.I., Gubonina I.V., Novikova V.P., Vigurskay M.Yu. Biliary dysfunction in obese children. Eksperimental’naya i klinicheskaya gastoenterologiya [Experimental and Clinical Gastroenterology]. 2014; 108 (8): 11–5. (in Russian)

37. Novikova V.P., Kalashnikova V.A. The condition of biliary tract in obesity in children. Eksperimental’naya i klinicheskaya gastoenterologiya [Experimental and Clinical Gastroenterology]. 2016; (1): 79–86. (in Russian)

38. Clemente M.G., Mandato C., Poeta M., Vajro P. Pediatric non-alcoholic fatty liver disease: Recent solutions, unresolved issues, and future research directions. World J Gastroenterol. 2016; 22 (36): 8078–93. DOI: https://doi.org/10.3748/wjg.v22.i36.8078

39. Maslennikov R.V., Evsyutina Yu.V. Non-alcoholic fatty liver disease, bile acids and intestinal microbiota. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii [Russian Journal of Gastroenterology, Hepatology, Coloproctology]. 2018; 28 (4): 84–90. DOI: https://doi.org/10.22416/1382-4376-2018-28-4-84-90 (in Russian)

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

SCImago Journal & Country Rank
Scopus CiteScore
CHIEF EDITOR
CHIEF EDITOR
Viktor A. Tutelyan
Full Member of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor, Scientific Director of the Federal Research Centre of Nutrition, Biotechnology and Food Safety (Moscow, Russia)

Journals of «GEOTAR-Media»