肥胖儿童非酒精性脂肪性肝病的患病率及危险因素分析

Prevalence and risk factors of non-alcoholic fatty liver disease in obese children

摘要

目的 调查肥胖儿童非酒精性脂肪性肝病(NAFLD)的患病率及其相关危险因素。方法 采用横断面研究,以2023年1月至2024年12月在西安交通大学附属儿童医院临床营养科就诊的223名2~18岁肥胖儿童[体质量指数z评分(BMI-z)≥2个标准差(SD)]为研究对象,同时纳入137名正常体重儿童作为对照组。收集体格检查、实验室检测和肝脏超声检查数据。采用卡方检验、t检验/方差分析及Logistic回归分析进行组间比较与危险因素筛选。结果 肥胖儿童中NAFLD的患病率为26.5%,显著高于正常体重组的2.2%(χ²=24.857,P＜0.001)。肥胖儿童中NAFLD的患病率随年龄增长而增加(χ²=18.274,P＜0.001),其中10~18岁青少年中患病率为46.5%。重度肥胖儿童的NAFLD患病率(32.8%)显著高于轻中度肥胖儿童(18.8%)(χ²=4.266,P=0.039)。进一步分析体成分指标发现,NAFLD组的体脂百分率[(39.92±5.39)%]、体脂量[(24.89±8.96)kg]、内脏脂肪面积[(104.62±37.27)cm²]和腰臀比(0.93±0.05)均显著高于非NAFLD组[相应值为(37.28±6.17)%、(18.07±8.05)kg、(76.41±43.17)cm²和0.89±0.06;t=3.027、5.672、4.883、4.632,P＜0.05]。因素Logistic回归分析显示,胰岛素抵抗(OR=2.495,95%CI:1.067~5.831)、肝功能异常(OR=17.130,95%CI:5.471~53.633)、高尿酸血症(OR=3.542,95%CI:1.570~7.992)和高体脂量(OR=2.311,95%CI:1.368~3.904)是肥胖儿童NAFLD发生的独立危险因素(P＜0.05)。结论 肥胖儿童,特别是重度肥胖及青春期(10~18岁)儿童中非酒精性脂肪性肝病的患病率较高。胰岛素抵抗、肝功能异常、高尿酸血症和高体脂量是其发生非酒精性脂肪性肝病的独立危险因素。

Abstract

Objective This study aimed to investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) and its associated risk factors among obese children. Methods A cross-sectional study was conducted among 223 obese children (BMI-z ≥ 2 SD),aged 2-18 years,who visited the Department of Clinical Nutrition at the Affiliated Children's Hospital of Xi'an Jiaotong University between January 2023 and December 2024.A control group of 137 normal-weight children was also included.Data were collected through physical examinations,laboratory tests,and liver ultrasonography.The chi-square test was used to compare prevalence rates between groups,while the t-test or analysis of variance (ANOVA) was applied for continuous variables.A logistic regression analysis was performed to identify independent risk factors for NAFLD. Results The prevalence of NAFLD in obese children was 26.5%,which was significantly higher than that of 2.2% in the normal weight group (χ²=24.857,P＜0.001).The prevalence of NAFLD in obese children increased with age (χ²=18.274,P＜0.001),and was 46.5% among adolescents aged 10 to 18 years.The prevalence of NAFLD was significantly higher in children with severe obesity (32.8%) than in children with mild to moderate obesity (18.8%) (χ²=4.266,P=0.039).Further analysis of body composition revealed that the NAFLD group had significantly higher body fat percentage [(39.92±5.39)%],body fat mass [(24.89±8.96)kg],visceral fat area [(104.62±37.27)cm²],and waist-to-hip ratio (0.93±0.05) compared with the non-NAFLD group [(37.28±6.17)%,(18.07±8.05)kg,(76.41±43.17)cm²,and (0.89±0.06),respectively;t=3.027,5.672,4.883,and 4.632,all P＜0.05].Multivariable logistic regression analysis showed that insulin resistance (OR=2.495,95%CI:1.067-5.831),abnormal liver function (OR=17.130,95%CI:5.471-53.633),hyperuricemia (OR=3.542,95%CI:1.570-7.992),and high body fat mass (OR=2.311,95%CI:1.368-3.904) were independent risk factors for the development of NAFLD in obese children (P＜0.05). Conclusion NAFLD is significantly more prevalent in obese children,particularly among adolescents and those with severe obesity.Insulin resistance,abnormal liver function,hyperuricemia,and elevated body fat mass are independent risk factors.

关键词

儿童 / 肥胖 / 非酒精性脂肪性肝病 / 患病率 / 危险因素

Key words

child / obesity / non-alcoholic fatty liver disease / prevalence / risk factor

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基金资助

西安市科技局立项课题(22YXYJ0076)

陕西省科技厅立项课题(2020SF-002)

中华国际科学交流基金会科技专项基金(Z2022LSXB007)