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Obez çocuklarda alkolsüz yağlı karaciğer hastalığı ile serum c-peptit, c-peptit-glikoz ve c-peptit-HbA1C oranı arasındaki ilişkinin değerlendirilmesi

Year 2020, Volume: 4 Issue: 12, 1128 - 1132, 01.12.2020
https://doi.org/10.28982/josam.778883

Abstract

Amaç: Obeziteye bağlı görülen metabolik sendrom, insulin direnci ve non-alkolik yağlı karaciğer hastalığı (NAYKH)gibi komplikasyonlar çocukluk çağında da sıklığı giderek artmaktadır. Bu çalışmanın amacı, NAYKH ile ilişkili obez çocuklarda açlık c-peptit, c-peptit-glukoz ve c-peptit-HbA1C oranlarını araştırmaktır.
Yöntemler: Bu vaka-kontrol çalışması Ağustos-Kasım 2018 arasında gerçekleştirildi. Çalışmaya 40'ı NAYKH ile ilişkili ve 20'si NAYKH olmayan toplam 60 obez çocuk alındı. VKİ> 2 z-skoru olan hastalar obez olarak kabul edildi. NAYKH’nin ultrasonografik özellikleri, karaciğer kontrastı ve ekojenitede parlaklık olarak tanımlandı. Hastaların serum açlık c-peptit düzeyleri karşılaştırıldı.
Bulgular: Çalışmaya dahil edilen 60 hastanın 37'si (%61,7) erkekti ve ortalama yaş 11,9 (2,9) yıldı. NAYKH'li hastalarda ortalama ALT, ağırlık, BMI, bel çevresi, bel çevresi-boy oranı, serum c-peptit, açlık c-peptit-glikoz oranı, açlık c-peptit-HbA1C oranı ve insülin seviyeleri, NAYKH olmayan obez çocuklara göre anlamlı olarak daha yüksekti. (her biri için P<0,05).
Bütün hastalar içinde ROC analizi ile değerlendirildiğinde, NAYKH’li hastalar için eğri altındaki alan 0,70 (%95 CI: 0,725-0,955) ve c peptit kesme değeri 2,62 ng / ml (duyarlılık %60, özgüllük %75, P=0,011) idi. Lojistik regresyon analizi ile, c-peptit seviyesi 2.62 ng / ml'den yüksek olan obez çocuklarda NAYKH riski anlamlı derecede daha yüksekti (OR: 4,52 %95 CI: 1,65-3,25) (P<0,001).
Sonuç: Bu çalışmada, NAYKH ile serum c-peptit düzeyi, c-peptit-glukoz ve c-peptit-HbA1C oranları arasında anlamlı bir ilişki bulunmuştur. NAYKH hastalarında insülin direncini belirlemede BMI, bel çevresi, bel-boy oranı, HbA1c ve insülin daha iyi standart parametreler olsa da, c-peptit tarama için pahalı olmayan bir yöntem olarak kullanılabilir.

References

  • 1. GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017;377(1):13.
  • 2. Goyal NP, Schwimmer JB. The progression and natural history of pediatric nonalcoholic fatty liver disease. Clin Liver Dis. 2016;20(2):325-38.
  • 3. Anderson EL, Howe LD, Jones HE, Higgins JP, Lawlor DA, Fraser A. The Prevalence of Non-Alcoholic Fatty Liver Disease in Children and Adolescents: A Systematic Review and Meta-Analysis. PLoS One. 2015;10(10):0140908. doi: 10.1371/journal.pone.0140908
  • 4. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73–84. doi: 10.1002/hep.28431
  • 5. Bozorgmanesh M, Hadaegh F, Khalili D, Prof AF. Prognostic Significance of the Complex "Visceral Adiposity Index" vs. Simple Anthropometric Measures. Cardiovasc Diabetol. 2012;11(20):1-10. doi: 10.1186/1475-2840-11-20
  • 6. Steiner DF, Cunningham D, Spigelman L, Aten B. Insulin Biosynthesis: Evidence for a Precursor. Science. 1967;157(3789):697–700. doi: 10.1126/science.157.3789.697.
  • 7. Li Y, Meng L, Li Y, Sato Y. Associations of Serum C Peptide Level with Body Fat Distribution and Ever Stroke in Nondiabetic Subjects. J Stroke Cerebrovasc Dis. 2013;23:63-9. doi: 10.1016/j.jstrokecerebrovasdis.2013.09.013
  • 8. Wang L, Lin P, Ma A, Zheng H, Wang K, Li W, et al. C-Peptide Is Independently Associated with an Increased Risk of Coronary Artery Disease in T2DM Subjects: A Cross-Sectional Study. PLoS One. 2015;10(6):0127112. doi: 10.1371/journal.pone.0127112
  • 9. Gonzalez-Mejia ME, Porchia LM, Torres-Rasgado E, Ruiz-Vivanco G, Pulido-Pérez P, Báez-Duarte BG, et al. C-Peptide Is a Sensitive Indicator for the Diagnosis of Metabolic Syndrome in Subjects from Central Mexico. Metab Syndr Relat Disord. 2016;14(4):210–6. doi: 10.1089/met.2015.0067
  • 10. WHO software World Health Organization (WHO) WHO anthroplus for personal computers manual software for assesing growth of the world’s children and adolescents.2009 http://.who.int/growthref/tools/who_anthroplus_manual.pdf (accessed May 2019).
  • 11. Berardis S, Sokal E. Pediatric non-alcoholic fatty liver disease: An increasing public health issue. Eur. J. Pediatr. 2014;173(2):131–9. doi: 10.1007/s00431-013-2157-6
  • 12. Yalaki S, Pülat H. Does chronic hepatitis B infection have an impact on fasting blood glucose levels and fatty liver development? J Surg Med. 2020;4(5):406-9. doi: 10.28982/josam.739568
  • 13. Atsawarungruangkit A, Chenbhanich J, Dickstein G. C-peptide as a key risk factor for non-alcoholic fatty liver disease in the United States population. World J Gastroenterol. 2018;24(32):3663–70. doi: 10.3748/wjg.v24.i32.3663
  • 14. Chen M, Li T, Zhang R, Li L, Lu J, Bao Y, et al. Clinical features of non-alcoholic fatty liver disease and its relationship with serum C-peptide levels in patients with latent autoimmune diabetes in adults. Zhonghua Yi Xue Za Zhi. 2015;95:3575–8.
  • 15. Chalasani N, Younossi Z, Lavine JE, Li L, Lu J, Bao Y, et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American association for the study of liver diseases, American college of gastroenterology, and the American gastroenterological association. Am. J. Gastroenterol. 2012;55(6):2005-23.
  • 16. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(1):81–90. doi:10.2337/dc14-S081
  • 17. Kulkarni CM, Patil S. Urinary C-peptide and urine C-peptide/creatinine ratio (UCPCR) are possible predictors of endogenous insulin secretion in T2DM subjects—a randomized study. Int J Pharma Bio Sci. 2016;7(4):443–6. doi: 10.22376/ijpbs.2016.7.4.b443-446
  • 18. Leighton E, Sainsbury CA, Jones GC. A Practical Review of C-Peptide Testing in Diabetes. Diabetes Ther. 2017;8(3):475–87. doi: 10.1007/s13300-017-0265-4
  • 19. El-Koofy NM, El-Karaksy HM, Mandour IM, Anwar GM, El-Raziky MS, El-Hennawy AM. Genetic polymorphisms in non-alcoholic fatty liver disease in obese Egyptian children. Saudi J Gastroenterol. 2011;17(4):265-7. doi: 10.4103/1319-3767.82582
  • 20. Saisho Y, Kou K, Tanaka K, Abe T, Kurosawa H, Shimada A, et al. Postprandial serum C-peptide to plasma glucose ratio as a predictor of subsequent insulin treatment in patients with type 2 diabetes. Endocr J. 2011;58(4):315–22. doi: 10.1507/endocrj.K10E-399
  • 21. Tricò D, Caprio S, Umano GR, Pierpont B, Nouws J, Galderisi A, et al. Santoro N. Metabolic Features of Nonalcoholic Fatty Liver (NAFL) in Obese Adolescents: Findings from a Multi-ethnic Cohort. Hepatology. 2018;68(4):1376-90. doi: 10.1002/hep.30035
  • 22. Francque SM, Verrijken A, Hubens G, Marck EV, Pelckmans P, et al. Noninvasive assessment of nonalcoholic fatty liver disease in obese or overweight patients. Clin Gastroenterol Hepatol. 2012;10(10):1162-8. doi: 10.1016/j.cgh.2012.06.019
  • 23. Manco M, Bedogni G, Marcellini M, Devito R, Ciampalini P, Sartorelli MR, et al. Waist circumference correlates with liver fibrosis in children with non-alcoholic steatohepatitis. Gut. 2008;57(9):1283–7. doi: 10.1136/gut.2007.142919.
  • 24. Monteiro PA, Antunes Bde M, Silveira LS, Christofaro DG, Fernandes RA, Freitas Junior IF. Body composition variables as predictors of NAFLD by ultrasound in obese children and adolescents. BMC Pediatr. 2014;14: 947. doi: 10.1186/1471-2431-14-25.
  • 25. Patel DA, Srinivasan SR, Chen W, Berenson GS. Serum alanine aminotransferase and its association with metabolic syndrome in children: the bogalusa heart study. Metab Syndr Relat Disord. 2001;9(3):211–6. doi: 10.1089/met.2010.0086.
  • 26. Arslan N, Büyükebiz B, Öztürk Y, Cakmak H. Fatty liver in obese children: prevalence and correlation with anthropometric measurements and hyperlipidemia. The Turkish Journal of Pediatrics. 2005;47:23-7.
  • 27. Fraser A, Longnecker MP, Lawlor DA. Prevalence of elevated alanine aminotransferase among US adolescents and associated factors: NHANES 1999–2004. Gastroenterology. 2007;133(6):1814–20. doi: 10.1053/j.gastro.2007.08.077
  • 28. Manco M, Alisi A, Nobili V. Risk of severe liver disease in NAFLD with normal ALT levels: a pediatric report. Hepatology. 2008;48(6):2087–8. doi: 10.1002/hep.22631.

Evaluation of the relationship between non-alcoholic fatty liver disease and serum c-peptide, c-peptide to glucose and c-peptide to HbA1C ratio in obese children

Year 2020, Volume: 4 Issue: 12, 1128 - 1132, 01.12.2020
https://doi.org/10.28982/josam.778883

Abstract

Aim: Obesity-related complications such as metabolic syndrome, insulin resistance and non-alcoholic fatty liver disease (NAFLD) have increased in childhood. The aim of this study is to investigate the fasting c-peptide, c-peptide to glucose and c-peptide to HbA1C ratios in obese children with NAFLD.
Methods: This case-control study was conducted from August through November 2018. A total of 60 obese children, 40 with and 20 without NAFLD, were included in the study. Patients with BMI > 2 z-score were considered obese. The ultrasonographic characteristics of NAFLD were identified with liver contrast and brightness in echogenicity. Serum fasting c-peptide levels of patients were compared.
Results: Of the 60 patients included in the study, 37 (61.7%) were male and the mean age was 11.9 (2.9) years. The mean ALT, weight BMI, waist circumference, waist to height ratio, serum c-peptide, fasting c-peptide to glucose ratio, fasting c-peptide to HbA1C ratio and insulin levels were considerably higher in patients with NAFLD (P<0.05 for each). When the c-peptide levels of all the patients was evaluated by ROC analysis, the area under the curve in patients with NAFLD was 0.70 (95% CL: 0.725-0.955) and the c-peptide cut off value was 2.62 ng/ml (sensitivity 60%, specificity 75%, P=0.011). Logistic regression analysis results showed that the risk of NAFLD was significantly higher in obese children with c-peptide levels greater than 2.62 ng/ml (OR: 4.52 95% CI: 1.65-3.25) (P<0.001).
Conclusion: In our study, a significant relationship was found between NAFLD and serum c-peptide level, c-peptide to glucose and c-peptide to HbA1C ratios. Even though BMI, waist circumference, waist to height ratio, HbA1c and insulin are better parameters in determining insulin resistance in NAFLD patients, c-peptide can be used as an inexpensive method for screening.

References

  • 1. GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017;377(1):13.
  • 2. Goyal NP, Schwimmer JB. The progression and natural history of pediatric nonalcoholic fatty liver disease. Clin Liver Dis. 2016;20(2):325-38.
  • 3. Anderson EL, Howe LD, Jones HE, Higgins JP, Lawlor DA, Fraser A. The Prevalence of Non-Alcoholic Fatty Liver Disease in Children and Adolescents: A Systematic Review and Meta-Analysis. PLoS One. 2015;10(10):0140908. doi: 10.1371/journal.pone.0140908
  • 4. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73–84. doi: 10.1002/hep.28431
  • 5. Bozorgmanesh M, Hadaegh F, Khalili D, Prof AF. Prognostic Significance of the Complex "Visceral Adiposity Index" vs. Simple Anthropometric Measures. Cardiovasc Diabetol. 2012;11(20):1-10. doi: 10.1186/1475-2840-11-20
  • 6. Steiner DF, Cunningham D, Spigelman L, Aten B. Insulin Biosynthesis: Evidence for a Precursor. Science. 1967;157(3789):697–700. doi: 10.1126/science.157.3789.697.
  • 7. Li Y, Meng L, Li Y, Sato Y. Associations of Serum C Peptide Level with Body Fat Distribution and Ever Stroke in Nondiabetic Subjects. J Stroke Cerebrovasc Dis. 2013;23:63-9. doi: 10.1016/j.jstrokecerebrovasdis.2013.09.013
  • 8. Wang L, Lin P, Ma A, Zheng H, Wang K, Li W, et al. C-Peptide Is Independently Associated with an Increased Risk of Coronary Artery Disease in T2DM Subjects: A Cross-Sectional Study. PLoS One. 2015;10(6):0127112. doi: 10.1371/journal.pone.0127112
  • 9. Gonzalez-Mejia ME, Porchia LM, Torres-Rasgado E, Ruiz-Vivanco G, Pulido-Pérez P, Báez-Duarte BG, et al. C-Peptide Is a Sensitive Indicator for the Diagnosis of Metabolic Syndrome in Subjects from Central Mexico. Metab Syndr Relat Disord. 2016;14(4):210–6. doi: 10.1089/met.2015.0067
  • 10. WHO software World Health Organization (WHO) WHO anthroplus for personal computers manual software for assesing growth of the world’s children and adolescents.2009 http://.who.int/growthref/tools/who_anthroplus_manual.pdf (accessed May 2019).
  • 11. Berardis S, Sokal E. Pediatric non-alcoholic fatty liver disease: An increasing public health issue. Eur. J. Pediatr. 2014;173(2):131–9. doi: 10.1007/s00431-013-2157-6
  • 12. Yalaki S, Pülat H. Does chronic hepatitis B infection have an impact on fasting blood glucose levels and fatty liver development? J Surg Med. 2020;4(5):406-9. doi: 10.28982/josam.739568
  • 13. Atsawarungruangkit A, Chenbhanich J, Dickstein G. C-peptide as a key risk factor for non-alcoholic fatty liver disease in the United States population. World J Gastroenterol. 2018;24(32):3663–70. doi: 10.3748/wjg.v24.i32.3663
  • 14. Chen M, Li T, Zhang R, Li L, Lu J, Bao Y, et al. Clinical features of non-alcoholic fatty liver disease and its relationship with serum C-peptide levels in patients with latent autoimmune diabetes in adults. Zhonghua Yi Xue Za Zhi. 2015;95:3575–8.
  • 15. Chalasani N, Younossi Z, Lavine JE, Li L, Lu J, Bao Y, et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American association for the study of liver diseases, American college of gastroenterology, and the American gastroenterological association. Am. J. Gastroenterol. 2012;55(6):2005-23.
  • 16. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(1):81–90. doi:10.2337/dc14-S081
  • 17. Kulkarni CM, Patil S. Urinary C-peptide and urine C-peptide/creatinine ratio (UCPCR) are possible predictors of endogenous insulin secretion in T2DM subjects—a randomized study. Int J Pharma Bio Sci. 2016;7(4):443–6. doi: 10.22376/ijpbs.2016.7.4.b443-446
  • 18. Leighton E, Sainsbury CA, Jones GC. A Practical Review of C-Peptide Testing in Diabetes. Diabetes Ther. 2017;8(3):475–87. doi: 10.1007/s13300-017-0265-4
  • 19. El-Koofy NM, El-Karaksy HM, Mandour IM, Anwar GM, El-Raziky MS, El-Hennawy AM. Genetic polymorphisms in non-alcoholic fatty liver disease in obese Egyptian children. Saudi J Gastroenterol. 2011;17(4):265-7. doi: 10.4103/1319-3767.82582
  • 20. Saisho Y, Kou K, Tanaka K, Abe T, Kurosawa H, Shimada A, et al. Postprandial serum C-peptide to plasma glucose ratio as a predictor of subsequent insulin treatment in patients with type 2 diabetes. Endocr J. 2011;58(4):315–22. doi: 10.1507/endocrj.K10E-399
  • 21. Tricò D, Caprio S, Umano GR, Pierpont B, Nouws J, Galderisi A, et al. Santoro N. Metabolic Features of Nonalcoholic Fatty Liver (NAFL) in Obese Adolescents: Findings from a Multi-ethnic Cohort. Hepatology. 2018;68(4):1376-90. doi: 10.1002/hep.30035
  • 22. Francque SM, Verrijken A, Hubens G, Marck EV, Pelckmans P, et al. Noninvasive assessment of nonalcoholic fatty liver disease in obese or overweight patients. Clin Gastroenterol Hepatol. 2012;10(10):1162-8. doi: 10.1016/j.cgh.2012.06.019
  • 23. Manco M, Bedogni G, Marcellini M, Devito R, Ciampalini P, Sartorelli MR, et al. Waist circumference correlates with liver fibrosis in children with non-alcoholic steatohepatitis. Gut. 2008;57(9):1283–7. doi: 10.1136/gut.2007.142919.
  • 24. Monteiro PA, Antunes Bde M, Silveira LS, Christofaro DG, Fernandes RA, Freitas Junior IF. Body composition variables as predictors of NAFLD by ultrasound in obese children and adolescents. BMC Pediatr. 2014;14: 947. doi: 10.1186/1471-2431-14-25.
  • 25. Patel DA, Srinivasan SR, Chen W, Berenson GS. Serum alanine aminotransferase and its association with metabolic syndrome in children: the bogalusa heart study. Metab Syndr Relat Disord. 2001;9(3):211–6. doi: 10.1089/met.2010.0086.
  • 26. Arslan N, Büyükebiz B, Öztürk Y, Cakmak H. Fatty liver in obese children: prevalence and correlation with anthropometric measurements and hyperlipidemia. The Turkish Journal of Pediatrics. 2005;47:23-7.
  • 27. Fraser A, Longnecker MP, Lawlor DA. Prevalence of elevated alanine aminotransferase among US adolescents and associated factors: NHANES 1999–2004. Gastroenterology. 2007;133(6):1814–20. doi: 10.1053/j.gastro.2007.08.077
  • 28. Manco M, Alisi A, Nobili V. Risk of severe liver disease in NAFLD with normal ALT levels: a pediatric report. Hepatology. 2008;48(6):2087–8. doi: 10.1002/hep.22631.
There are 28 citations in total.

Details

Primary Language English
Subjects Gastroenterology and Hepatology
Journal Section Research article
Authors

Fatma Demirbaş 0000-0003-1788-2559

Gönül Dinler Çaltepe 0000-0001-8525-6352

Atakan Comba 0000-0002-8576-9550

Hasan Abbasguliyev This is me 0000-0002-1055-0925

Ayhan Gazi  Kalaycı 0000-0003-2104-6801

Publication Date December 1, 2020
Published in Issue Year 2020 Volume: 4 Issue: 12

Cite

APA Demirbaş, F., Dinler Çaltepe, G., Comba, A., Abbasguliyev, H., et al. (2020). Evaluation of the relationship between non-alcoholic fatty liver disease and serum c-peptide, c-peptide to glucose and c-peptide to HbA1C ratio in obese children. Journal of Surgery and Medicine, 4(12), 1128-1132. https://doi.org/10.28982/josam.778883
AMA Demirbaş F, Dinler Çaltepe G, Comba A, Abbasguliyev H, Kalaycı AG. Evaluation of the relationship between non-alcoholic fatty liver disease and serum c-peptide, c-peptide to glucose and c-peptide to HbA1C ratio in obese children. J Surg Med. December 2020;4(12):1128-1132. doi:10.28982/josam.778883
Chicago Demirbaş, Fatma, Gönül Dinler Çaltepe, Atakan Comba, Hasan Abbasguliyev, and AyhanGazi Kalaycı. “Evaluation of the Relationship Between Non-Alcoholic Fatty Liver Disease and Serum C-Peptide, C-Peptide to Glucose and C-Peptide to HbA1C Ratio in Obese Children”. Journal of Surgery and Medicine 4, no. 12 (December 2020): 1128-32. https://doi.org/10.28982/josam.778883.
EndNote Demirbaş F, Dinler Çaltepe G, Comba A, Abbasguliyev H, Kalaycı AG (December 1, 2020) Evaluation of the relationship between non-alcoholic fatty liver disease and serum c-peptide, c-peptide to glucose and c-peptide to HbA1C ratio in obese children. Journal of Surgery and Medicine 4 12 1128–1132.
IEEE F. Demirbaş, G. Dinler Çaltepe, A. Comba, H. Abbasguliyev, and A. G. Kalaycı, “Evaluation of the relationship between non-alcoholic fatty liver disease and serum c-peptide, c-peptide to glucose and c-peptide to HbA1C ratio in obese children”, J Surg Med, vol. 4, no. 12, pp. 1128–1132, 2020, doi: 10.28982/josam.778883.
ISNAD Demirbaş, Fatma et al. “Evaluation of the Relationship Between Non-Alcoholic Fatty Liver Disease and Serum C-Peptide, C-Peptide to Glucose and C-Peptide to HbA1C Ratio in Obese Children”. Journal of Surgery and Medicine 4/12 (December 2020), 1128-1132. https://doi.org/10.28982/josam.778883.
JAMA Demirbaş F, Dinler Çaltepe G, Comba A, Abbasguliyev H, Kalaycı AG. Evaluation of the relationship between non-alcoholic fatty liver disease and serum c-peptide, c-peptide to glucose and c-peptide to HbA1C ratio in obese children. J Surg Med. 2020;4:1128–1132.
MLA Demirbaş, Fatma et al. “Evaluation of the Relationship Between Non-Alcoholic Fatty Liver Disease and Serum C-Peptide, C-Peptide to Glucose and C-Peptide to HbA1C Ratio in Obese Children”. Journal of Surgery and Medicine, vol. 4, no. 12, 2020, pp. 1128-32, doi:10.28982/josam.778883.
Vancouver Demirbaş F, Dinler Çaltepe G, Comba A, Abbasguliyev H, Kalaycı AG. Evaluation of the relationship between non-alcoholic fatty liver disease and serum c-peptide, c-peptide to glucose and c-peptide to HbA1C ratio in obese children. J Surg Med. 2020;4(12):1128-32.