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.
Full Text:PDF (Українська)
Lobstein T, Jackson-Leach R. Estimated burden of paediatric obesity and co-morbidities in Europe. Part 2. Numbers of children with indicators of obesity-related disease. Int J Pediatr Obes. 2006;1(1):33-41. doi: 10.1080/17477160600586689
Berenson GS, Srinivasan SR, Bao W. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. New England Journal of Medicine. 1998;338(23):1650-6. doi: 10.1056/NEJM199806043382302
Catanzaro R, Cuffari B, Italia A, Marotta F. Exploring the metabolic syndrome: Nonalcoholic fatty pancreas disease. World Journal of Gastroenterology. 2016;22(34):7660-75. doi:10.3748/wjg.v22.i34.7660
Zvenyhorodskaya LA, Samsonova NG. Clinical and diagnostic features of steatosis of the pancreas in patients with the metabolic syndrome. Journal of Family Medicine. 2015;1(2):30-36. (in Russian).
Siddiqui MS, Cheang KL, Luketic VA, et al. Nonalcoholic Steatohepatitis (NASH) Is Associated with a Decline in Pancreatic Beta Cell (β-Cell) Function. Dig Dis Sci. 2015 Aug;60(8):2529-37. doi: 10.1007/s10620-015-3627-7
Targher G, Rossi AP, Zamboni GA, Fantin F, Antonioli A, Corzato F et al. Pancreatic fat accumulation and its relationship with liver fat content and other fat depots in obese individuals. J. Endocrinol Invest. 2012;35(8):748-53. doi: 10.3275/8011
Lesmana CRA, Pakasi LS, Inggriani S, Aidawati ML, Lesmana LA. Prevalence of Non-Alcoholic Fatty Pancreas Disease (NAFPD) and its risk factors among adult medical check-up patients in a private hospital: a large cross sectional study. BMC Gastroenterology. 2015;15(1):174. doi: 10.1186/s12876-015-0404-1
Kim MK, Chun HJ, Park JH, Yeo DM, Baek KH, Song KH. The association between ectopic fat in the pancreas and subclinical atherosclerosis in type 2 diabetes. Diabetes Res Clin Pract. 2014 Dec;106(3):590-6. doi: 10.1016/j.diabres.2014.09.005
World Health Organization: Growth reference 5-19 years. BMI-for-age (5-19 years). Available at: http://www.who.int/growthref/who2007_bmi_for_age/en/
Fernández JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J. Pediatr. 2004;145(4):439-44. doi: 10.1016/j.jpeds.2004.06.044
Wan-Chen W, Wang C-Y. Association between non-alcoholic fatty pancreatic disease (nafpd) and the metabolic syndrome: case-control retrospective study. Cardiovascular Diabetolog. 2013;12:77. doi: 10.1186/1475-2840-12-77
- There are currently no refbacks.
Copyright (c) 2017 GASTROENTEROLOGY
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2017