Clinical and laboratory features of pancreatic steatosis in children with overweight and obesity
Background. Nonalcoholic fatty pancreas disease is a pathological condition associated with obesity and components of the metabolic syndrome. Clinical features of the pancreatic steatosis can be caused by exocrine insufficiency, which is accompanied with the development of dysbiotic changes and intestinal disorders. The aim of the study was to examine the clinical and laboratory features of pancreatic steatosis in children with overweight and obesity. Materials and methods. We determined the presence of pancreatic steatosis by ultrasound examination of the abdominal cavity in 24 children with disorders of the gastrointestinal tract. To characterize the state of the intestinal microbiota, a hydrogen breath test with a load of glucose or lactose was carried out. Determination of hepatic steatosis was performed using transient liver elastography (FibroScan) with determination of controlled attenuation parameter. Patients were divided into 2 groups: a control group (S0) was presented by 12 patients without pancreatic steatosis, the main group (S+) — 12 patients with pancreatic steatosis. Results. Pancreatic steatosis in children with overweight and obesity was characterized by nonspecific clinical picture with the prevalence of dyspepsia. Children with pancreatic steatosis had lower levels of serum amylase compared to control group (mean value was (30.40 ± 12.45) mmol/l in the main group and (51.88 ± 19.81) mmol/l — in the control, p < 0.05). Also, patients of the main group had significantly more common incudence of steatorrhea during coprological study (75 % of children of the main group vs. 33.3 % in the control group, p < 0.05). Pancreatic steatosis in children was associated with development of small intestinal bacterial overgrowth (50 % of children of the main group vs. 8.3 % in the control group, p < 0.05). Among patients with pancreatic steatosis, 41.6 % had signs of liver steatosis, whereas pancreatic steatosis was found in 62.5 % of patients with nonalcoholic fatty liver disease. Children with pancreatic steatosis had moderate acceleration of erythrocyte sedimentation rate (average level was (16.60 ± 6.76) mm/h in patients of the main group vs. (7.17 ± 3.18) mm/h in the control group). Conclusions. Pancreatic steatosis may be a better marker of early ectopic fat accumulation compared with liver steatosis. Рancreatic steatosis in children with overweight and obesity is characterized by low level of systemic inflammation, dyspepsia, indirect signs of exocrine pancreatic insufficiency and small intestinal bacterial overgrowth.
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