Lipid markers for predicting non-alcoholic fatty liver disease in adolescent boys with hypoandrogenism
DOI:
https://doi.org/10.15574/SP.2022.127.46Keywords:
adolescent boys, non-alcoholic fatty liver disease, hypoandrogenism, β-lipoproteins, prognostic valueAbstract
Metabolic syndrome (MS) and the conditions associated with it are pressing problems for humanity. The gastroenterological component of MS is considered to be non-alcoholic fatty liver disease (NAFLD). There are no scientific studies on the influence of hypoandrogenism (HA) on metabolic control and the formation of NAFLD in adolescent boys.
Purpose - to determine the prognostic value of changes in the lipid profile for the formation of NAFLD in adolescent boys with HA.
Materials and methods. In 2019-2021 was carried out a comprehensive examination of 107 adolescent boys aged 13-18 with HA: the clinical examination, blood tests to determine the level of γ-glutamyltransferase, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, lipidogram, testosterone, immunoreactive insulin. The morpho-functional state of the hepatobiliary system was studied by ultrasound, according to the results of which adolescent boys with HA were divided into observation groups (the Group 1 - with normal liver parameters, the Group 2 - with signs of steatosis). Prognostic assessment of the formation of liver steatosis in HA was carried out using ROC analysis with AUC calculation.
Results. According to the ultrasound signs of NAFLD was detected in a third of adolescent boys with HA. The state of insulin resistance was established in 22% of adolescent boys, significantly more often in patients with NAFLD. Analysis of blood lipid spectrum indicators in young men with HA showed the presence of proatherogenic changes more pronounced in the group with NAFLD. ROC analysis for quantitative biochemical indicators demonstrated that while using the distribution point for β-lipoproteins >5.8 g/l for the detection of liver enlargement as a sign of NAFLD in adolescent boys with HA the sensitivity was 72.0%, the specificity - 55.3%. The value of the area under the ROC curve was 0.624 [0.514; 0.725] with the level of statistical significance p=0.045.
Conclusions. A third part of adolescent boys with HA according to ultrasound examination had signs of NAFLD at the stage of steatosis. Atherogenic dyslipidemia was found in all adolescents with HA, which was more pronounced in patients with NAFLD. The predictive value of determining the level of β-lipoproteins for the detection of NAFLD in adolescent boys with HA was revealed. The determination of β-lipoproteins may be economically feasible in relation to the diagnostic examination of adolescent boys with HA.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
References
Agudelo G, Bedoya G, Estrada A et al. (2014). Variations in the prevalence of metabolic syndrome in adolescents according to different criteria used for diagnosis: which definition should be chosen for this age group? Metabolic Syndrome and Related Disorders. May 2014: 202-209. https://doi.org/10.1089/met.2013.0127; PMid:24564686
Al-Hamad D, Raman V. (2017). Metabolic syndrome in children and adolescents. Translational Pediatrics. 6 (4): 397-407. https://doi.org/10.21037/tp.2017.10.02; PMid:29184820 PMCid:PMC5682379
Antonio L, Wu FCW, O'Neill TW et al. (2015). Associations between sex steroids and the development of metabolic syndrome: a longitudinal study in European men. The Journal of Clinical Endocrinology & Metabolism. 100 (4): 1396-1404. https://doi.org/10.1210/jc.2014-4184; PMid:25636052
Buznytska OV. (2022). Characteristics of lipid metabolism in adolescents with obesity and signs of metabolic syndrome. Modern Pediatrics. Ukraine. 1 (121): 49-54. https://doi.org/10.15574/SP.2022.121.49
Chalasani N, Younossi Z, Lavine JE et al. (2018). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 67 (1): 328-357. https://doi.org/10.1002/hep.29367; PMid:28714183
Corte CD, Alisi A, Saccari A et al. (2015). Nonalcoholic fatty liver in children and adolescents: an overview. Journal of Аdolescent Нealth. 51 (4): 305-312. https://doi.org/10.1016/j.jadohealth.2012.01.010; PMid:22999829
Cunningham GR. (2015). Testosterone and metabolic syndrome. Asian Journal of Andrology. 17 (2): 192-196. https://doi.org/10.4103/1008-682X.148068; PMid:25652634 PMCid:PMC4650473
Ebrahimi F, Christ-Crain M. (2016). Metabolic syndrome and hypogonadism-two peas in a pod. Swiss Medical Weekly. 21 (146): 4283. https://doi.org/10.4414/smw.2016.14283; PMid:26999489
European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). (2016). Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. Journal of Нepatology. 64 (6): 1388-1402. https://doi.org/10.1016/j.jhep.2015.11.004; PMid:27062661
Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (2001). Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP). Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 285: 2486-2497. https://doi.org/10.1001/jama.285.19.2486; PMid:11368702
GBD 2015 Risk Factors Collaborators. (2016). Global, regional, and national comparative risk assessment of 79 behavioral, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 388 (10053): 1659-1724. https://doi.org/10.1016/S0140-6736(16)31679-8; PMid:27733284
Gromnatska N, Cherkas A, Lemishko B, Kulya O. (2019). The pattern of metabolic syndrome in children with abdominal obesity. Georgian Med News. 289: 68-72.
Heinonen OP, Huttunen JK, Manninen V et al. (1994). The Helsinki Heart Study: coronary heart disease incidence during an extended follow-up. Journal of Internal Medicine. 235 (1): 41-49. https://doi.org/10.1111/j.1365-2796.1994.tb01030.x; PMid:8283158
Khazai B, Golden SH, Colangelo LA et al. (2016). Association of endogenous testosterone with subclinical atherosclerosis in men: the multi-ethnic study of atherosclerosis. Clinical Еndocrinology. 84 (5): 700-707. https://doi.org/10.1111/cen.12997; PMid:26663365
Magge SN, Goodman E, Armstrong SC et al. (2017). The metabolic syndrome in children and adolescents: shifting the focus to cardiometabolic risk factor clustering. Pediatrics. 140 (2): 2017-1603. https://doi.org/10.1542/peds.2017-1603; PMid:28739653
Mantovania А, Zaza G, Byrne CD. (2018). Nonalcoholic fatty liver disease: A systematic review and meta-analysis. Metabolism. 79: 64-76. https://doi.org/10.1016/j.metabol.2017.11.003
PMid:29137912
Ministry of Health of Ukraine. (2013). On the approval of unified clinical protocols for medical care for children with diseases of the digestive system. Order of the Ministry of Health of Ukraine adopted on January 29 No. 59. URL: https://zakon.rada.gov.ua/rada/show/v0059282-13.
Mody A, White D, Kanwal F et al. (2015). Relevance of low testosterone to non-alcoholic fatty liver disease. Cardiovascular Endocrinology. 1; 4 (3): 83-89. https://doi.org/10.1097/XCE.0000000000000057; PMid:26405614 PMCid:PMC4577238
Onat A, Can G, Kaya A et al. (2015). Fatty liver disease: Disparate predictive ability for cardiometabolic risk and all-cause mortality. World Journal of Gastroenterology. 28; 21 (48): 13555-13565. https://doi.org/10.3748/wjg.v21.i48.13555; PMid:26730168 PMCid:PMC4690186
Parkhomenko LK, Strashok LA, Turchyna SI et al. (2021). Mechanisms of hepatic steatosis formation in adolescent boys with hypoandrogenism. Reproductive Endocrinology. 57: 79-83. https://doi.org/10.18370/2309-4117.2021.57.79-83
Turchina S I, Коstenko ТP, Kosovtsova GV, Varodova ОV. (2020). Criteria of hypoandrogenism in adolescent boys. Ukrainian journal of pediatric endocrinology. 4: 14-19. https://doi.org/10.30978/UJPE2020-4-14
Ventimiglia E, Capogrosso P, Serino A et al. (2016). Metabolic syndrome in White-European men presenting for secondary couple's infertility: an investigation of the clinical and reproductive burden. Asian J Androl. 19 (3): 368-373. https://doi.org/10.4103/1008-682X.175783; PMid:27004539 PMCid:PMC5427796
Vos MB, Abrams SH, Barlow SE et al. (2017). NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children: Recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). Journal of Pediatric Gastroenterology and Nutrition. 64 (2): 319-334. https://doi.org/10.1097/MPG.0000000000001482; PMid:28107283 PMCid:PMC5413933
Weiss R, Bremer A, Lustig R. (2013). What is metabolic syndrome, and why are children getting it? Annals of the New York Academy of Sciences. 1281: 123-140. https://doi.org/10.1111/nyas.12030; PMid:23356701 PMCid:PMC3715098
Winter AG, Zhao F, Lee RK. (2014). Androgen deficiency and metabolic syndrome in men. Translational Andrologv and Urology. 3 (1): 50-58. doi: 10.3978/j.issn.2223-4683.2014.01.04.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Modern pediatrics. Ukraine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “MODERN PEDIATRICS. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
