Noninvasive Parameters and hepatic fibrosis scores in children with nonalcoholic fatty liver disease

Table 1 Patient characteristics and comparisons of noninvasive biochemical parameters between mild fibrosis and significant fibrosis regarding the hepatic histology of children with non-alcoholic fatty liver disease (mean ± SD)

Parameters	Total (n = 77)	Mild fibrosis(stage 0-1) (n = 51)	Significant fibrosis(stage 2-3) (n = 26)	P value
Clinical characteristics
Gender (M:F)	66:11	42:9	24:2	0.316
Age (yr)	12.2 ± 2.3	12.0 ± 2.4	12.7 ± 1.9	0.132
AC (cm)	91.1 ± 10.1	92.1 ± 11.6	89.7 ± 7.8	0.637
Weight (kg)	68.9 ± 19.3	68.3 ± 21.3	70.2 ± 15.1	0.448
Height (cm)	155.5 ± 12.2	155.1 ± 12.1	156.3 ± 12.6	0.407
BMI (kg/m2)	28.1 ± 5.1	27.8 ± 5.2	28.7 ± 5.1	0.425
Biochemical parameters
AST (IU/L)	82.1 ± 46.6	77.4 ± 46.3	91.3 ± 46.8	0.063
ALT (IU/L)	167.4 ± 99.1	158.7 ± 95.4	184.6 ± 105.6	0.206
ALP (IU/L)	283.7 ± 110.0	273.0 ± 113.8	304.7 ± 101.1	0.185
γGT (IU/L)	53.9 ± 29.1	51.1 ± 25.9	59.4 ± 34.4	0.410
Total bilirubin (mg/dL)	0.76 ± 0.37	0.75 ± 0.30	0.77 ± 0.50	0.438
Albumin (g/dL)	4.54 ± 0.31	4.54 ± 0.32	4.55 ± 0.30	1.000
PT INR	1.02 ± 0.07	1.01 ± 0.06	1.03 ± 0.08	0.090
Total cholesterol (mg/dL)	180.2 ± 32.6	176.8 ± 31.2	186.9 ± 34.7	0.139
Triglyceride (mg/dL)	132.8 ± 53.6	126.6 ± 52.4	142.7 ± 55.0	0.235
LDL cholesterol (mg/dL)	97.2 ± 24.9	93.5 ± 20.6	103.1 ± 30.2	0.198
HDL cholesterol (mg/dL)	48.1 ± 11.4	48.9 ± 12.2	46.9 ± 10.2	0.995
Apoprotein A1 (mg/dL)	120.2 ± 15.9	121.6 ± 15.7	118.1 ± 16.8	0.543
Apoprotein B (mg/dL)	83.5 ± 17.7	85.6 ± 17.5	80.0 ± 18.3	0.418
Fasting glucose (mg/dL)	98.1 ± 34.2	95.4 ± 11.9	103.4 ± 56.7	0.311
Insulin (μIU/mL)	24.6 ± 14.6	23.2 ± 15.5	26.2 ± 13.5	0.244
HOMA-IR	5.8 ± 4.3	6.1 ± 4.8	5.3 ± 3.2	0.586
TNF-α (pg/mL)	18.2 ± 15.0	15.7 ± 12.3	21.7 ± 18.0	0.400
HbA1C (%)	5.7 ± 1.1	5.5 ± 0.3	5.9 ± 1.6	0.806
Platelet (× 109/L)	307.9 ± 69.2	313.2 ± 71.1	297.3 ± 65.4	0.416

AC: Abdominal circumference; ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMI: Body mass index; γGT: γ-glutamyl transpeptidase; DBP: Diastolic blood pressure; HDL: High density lipoprotein; HOMA-IR: Insulin resistance determined by homeostasis model assessment; LDL: Low density lipoprotein; NAFLD: Non-alcoholic fatty liver disease; NAS: NAFLD activity score; Ob: Obesity; Ow: Overweight; PT: Prothrombin time; SBP: Systolic blood pressure; TNF-α: Tumor necrosis factor-α.

Table 2 Comparison of hepatic fibrosis scoring systems between mild fibrosis and significant fibrosis regarding the hepatic histology of children with non-alcoholic fatty liver disease (mean ± SD)

Parameters and hepatic fibrosis scores	Total (n = 77)	Mild fibrosis(stage 0-1) (n = 51)	Significant fibrosis(stage 2-3) (n = 26)	P value
Invasive histopathologic NAFLD scores1
Steatosis (grade 0/1/2/3)	0/13/36/28	0/7/22/22	0/6/14/6	0.085
Inflammation (grade 0/1/2/3)	9/43/25/0	7/29/15/0	2/14/10/0	0.325
Ballooning (grade 0/1/2)	27/33/17	22/21/8	5/12/9	0.018
NAS	4.3 ± 1.4	4.18 ± 1.48	4.46 ± 1.14	0.470
Noninvasive hepatic fibrosis scoring systems
AST/ALT ratio	0.53 ± 0.22	0.52 ± 0.16	0.57 ± 0.31	0.802
AST/platelet ratio index	0.71 ± 0.49	0.67 ± 0.54	0.78 ± 0.38	0.032
PGA index	3.78 ± 1.80	3.85 ± 1.89	3.68 ± 1.70	0.710
Forns index	-0.94 ± 1.18	-1.06 ± 0.21	-0.69 ± 1.09	0.097
FIB4 score	0.27 ± 0.16	0.24 ± 0.12	0.31 ± 0.21	0.010
NAFLD fibrosis score	-4.95 ± 1.32	-5.07 ± 1.27	-4.73 ± 1.41	0.532
Pediatric NAFLD fibrosis index	7.67 ± 2.48	7.71 ± 2.79	7.61 ± 2.08	0.314

¹Histopathologic non-alcoholic fatty liver disease (NAFLD) scoring on liver biopsy specimens was based on the definition by Kleiner et al[13]. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; NAS: Non-alcoholic fatty liver disease activity score.

Table 3 Multivariate logistic regression analysis for significant hepatic fibrosis in children with non-alcoholic fatty liver disease

Variables	OR	95% CI	P value
Age	1.357	1.027-1.793	0.032
ALP	1.006	1.000-1.011	0.035

ALP: Alkaline phosphatase; OR: Odds ratio.