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Adipokines and C-reactive protein in relation to bone mineralization in pediatric nonalcoholic fatty liver disease.
World J Gastroenterol. 2013 Jul 07; 19(25):4007-14.WJ

Abstract

AIM

To investigate bone mineral density (BMD) in obese children with and without nonalcoholic fatty liver disease (NAFLD); and the association between BMD and serum adipokines, and high-sensitivity C-reactive protein (HSCRP).

METHODS

A case-control study was performed. Cases were 44 obese children with NAFLD. The diagnosis of NAFLD was based on magnetic resonance imaging (MRI) with high hepatic fat fraction (≥ 5%). Other causes of chronic liver disease were ruled out. Controls were selected from obese children with normal levels of aminotransferases, and without MRI evidence of fatty liver as well as of other causes of chronic liver diseases. Controls were matched (1- to 1-basis) with the cases on age, gender, pubertal stage and as closely as possible on body mass index-SD score. All participants underwent clinical examination, laboratory tests, and whole body (WB) and lumbar spine (LS) BMD by dual energy X-ray absorptiometry. BMD Z-scores were calculated using race and gender specific LMS curves.

RESULTS

Obese children with NAFLD had a significantly lower LS BMD Z-score than those without NAFLD [mean, 0.55 (95%CI: 0.23-0.86) vs 1.29 (95%CI: 0.95-1.63); P < 0.01]. WB BMD Z-score was also decreased in obese children with NAFLD compared to obese children with no NAFLD, though borderline significance was observed [1.55 (95%CI: 1.23-1.87) vs 1.95 (95%CI: 1.67-2.10); P = 0.06]. Children with NAFLD had significantly higher HSCRP, lower adiponectin, but similar leptin levels. Thirty five of the 44 children with MRI-diagnosed NAFLD underwent liver biopsy. Among the children with biopsy-proven NAFLD, 20 (57%) had nonalcoholic steatohepatitis (NASH), while 15 (43%) no NASH. Compared to children without NASH, those with NASH had a significantly lower LS BMD Z-score [mean, 0.27 (95%CI: -0.17-0.71) vs 0.75 (95%CI: 0.13-1.39); P < 0.05] as well as a significantly lower WB BMD Z-score [1.38 (95%CI: 0.89-1.17) vs 1.93 (95%CI: 1.32-2.36); P < 0.05]. In multiple regression analysis, NASH (standardized β coefficient, -0.272; P < 0.01) and HSCRP (standardized β coefficient, -0.192; P < 0.05) were significantly and independently associated with LS BMD Z-score. Similar results were obtained when NAFLD (instead of NASH) was included in the model. WB BMD Z-scores were significantly and independently associated with NASH (standardized β coefficient, -0.248; P < 0.05) and fat mass (standardized β coefficient, -0.224; P < 0.05).

CONCLUSION

This study reveals that NAFLD is associated with low BMD in obese children, and that systemic, low-grade inflammation may accelerate loss of bone mass in patients with NAFLD.

Authors+Show Affiliations

Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23840146

Citation

Pacifico, Lucia, et al. "Adipokines and C-reactive Protein in Relation to Bone Mineralization in Pediatric Nonalcoholic Fatty Liver Disease." World Journal of Gastroenterology, vol. 19, no. 25, 2013, pp. 4007-14.
Pacifico L, Bezzi M, Lombardo CV, et al. Adipokines and C-reactive protein in relation to bone mineralization in pediatric nonalcoholic fatty liver disease. World J Gastroenterol. 2013;19(25):4007-14.
Pacifico, L., Bezzi, M., Lombardo, C. V., Romaggioli, S., Ferraro, F., Bascetta, S., & Chiesa, C. (2013). Adipokines and C-reactive protein in relation to bone mineralization in pediatric nonalcoholic fatty liver disease. World Journal of Gastroenterology, 19(25), 4007-14. https://doi.org/10.3748/wjg.v19.i25.4007
Pacifico L, et al. Adipokines and C-reactive Protein in Relation to Bone Mineralization in Pediatric Nonalcoholic Fatty Liver Disease. World J Gastroenterol. 2013 Jul 7;19(25):4007-14. PubMed PMID: 23840146.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adipokines and C-reactive protein in relation to bone mineralization in pediatric nonalcoholic fatty liver disease. AU - Pacifico,Lucia, AU - Bezzi,Mario, AU - Lombardo,Concetta Valentina, AU - Romaggioli,Sara, AU - Ferraro,Flavia, AU - Bascetta,Stefano, AU - Chiesa,Claudio, PY - 2013/02/13/received PY - 2013/04/02/revised PY - 2013/04/18/accepted PY - 2013/7/11/entrez PY - 2013/7/11/pubmed PY - 2014/2/18/medline KW - Adipokines KW - Bone mineralization KW - C-reactive protein KW - Children KW - Dual energy X-ray absorptiometry KW - Nonalcoholic fatty liver disease SP - 4007 EP - 14 JF - World journal of gastroenterology JO - World J Gastroenterol VL - 19 IS - 25 N2 - AIM: To investigate bone mineral density (BMD) in obese children with and without nonalcoholic fatty liver disease (NAFLD); and the association between BMD and serum adipokines, and high-sensitivity C-reactive protein (HSCRP). METHODS: A case-control study was performed. Cases were 44 obese children with NAFLD. The diagnosis of NAFLD was based on magnetic resonance imaging (MRI) with high hepatic fat fraction (≥ 5%). Other causes of chronic liver disease were ruled out. Controls were selected from obese children with normal levels of aminotransferases, and without MRI evidence of fatty liver as well as of other causes of chronic liver diseases. Controls were matched (1- to 1-basis) with the cases on age, gender, pubertal stage and as closely as possible on body mass index-SD score. All participants underwent clinical examination, laboratory tests, and whole body (WB) and lumbar spine (LS) BMD by dual energy X-ray absorptiometry. BMD Z-scores were calculated using race and gender specific LMS curves. RESULTS: Obese children with NAFLD had a significantly lower LS BMD Z-score than those without NAFLD [mean, 0.55 (95%CI: 0.23-0.86) vs 1.29 (95%CI: 0.95-1.63); P < 0.01]. WB BMD Z-score was also decreased in obese children with NAFLD compared to obese children with no NAFLD, though borderline significance was observed [1.55 (95%CI: 1.23-1.87) vs 1.95 (95%CI: 1.67-2.10); P = 0.06]. Children with NAFLD had significantly higher HSCRP, lower adiponectin, but similar leptin levels. Thirty five of the 44 children with MRI-diagnosed NAFLD underwent liver biopsy. Among the children with biopsy-proven NAFLD, 20 (57%) had nonalcoholic steatohepatitis (NASH), while 15 (43%) no NASH. Compared to children without NASH, those with NASH had a significantly lower LS BMD Z-score [mean, 0.27 (95%CI: -0.17-0.71) vs 0.75 (95%CI: 0.13-1.39); P < 0.05] as well as a significantly lower WB BMD Z-score [1.38 (95%CI: 0.89-1.17) vs 1.93 (95%CI: 1.32-2.36); P < 0.05]. In multiple regression analysis, NASH (standardized β coefficient, -0.272; P < 0.01) and HSCRP (standardized β coefficient, -0.192; P < 0.05) were significantly and independently associated with LS BMD Z-score. Similar results were obtained when NAFLD (instead of NASH) was included in the model. WB BMD Z-scores were significantly and independently associated with NASH (standardized β coefficient, -0.248; P < 0.05) and fat mass (standardized β coefficient, -0.224; P < 0.05). CONCLUSION: This study reveals that NAFLD is associated with low BMD in obese children, and that systemic, low-grade inflammation may accelerate loss of bone mass in patients with NAFLD. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/23840146/Adipokines_and_C_reactive_protein_in_relation_to_bone_mineralization_in_pediatric_nonalcoholic_fatty_liver_disease_ L2 - https://www.wjgnet.com/1007-9327/full/v19/i25/4007.htm DB - PRIME DP - Unbound Medicine ER -