Alterations in ventricular structure and function in obese adolescents with nonalcoholic fatty liver disease - PubMed (original) (raw)

Alterations in ventricular structure and function in obese adolescents with nonalcoholic fatty liver disease

Gautam K Singh et al. J Pediatr. 2013 Jun.

Abstract

Objective: To determine the association among nonalcoholic fatty liver disease (NAFLD), metabolic function, and cardiac function in obese adolescents.

Study design: Intrahepatic triglyceride (IHTG) content (magnetic resonance spectroscopy), insulin sensitivity and β-cell function (5-hour oral glucose tolerance test with mathematical modeling), and left ventricular function (speckle tracking echocardiography) were determined in 3 groups of age, sex, and Tanner matched adolescents: (1) lean (n=14, body mass index [BMI]=20±2 kg/m2); (2) obese with normal (2.5%) IHTG content (n=15, BMI=35±3 kg/m2); and (3) obese with increased (8.7%) IHTG content (n=15, BMI=37±6 kg/m2).

Results: The disposition index (β-cell function) and insulin sensitivity index were ∼45% and ∼70% lower, respectively, and whole body insulin resistance, calculated by homeostasis model of assessment-insulin resistance (HOMA-IR), was ∼60% greater, in obese than in lean subjects, and ∼30% and ∼50% lower and ∼150% greater, respectively, in obese subjects with NAFLD than those without NAFLD (P<.05 for all). Left ventricular global longitudinal systolic strain and early diastolic strain rates were significantly decreased in obese than in lean subjects, and in obese subjects with NAFLD than those without NAFLD (P<.05 for all), and were independently associated with HOMA-IR (β=0.634). IHTG content was the only significant independent determinant of insulin sensitivity index (β=-0.770), disposition index (β=-0.651), and HOMA-IR (β=0.738).

Conclusions: These findings demonstrate that the presence of NAFLD in otherwise asymptomatic obese adolescents is an early marker of cardiac dysfunction.

Copyright © 2013 Mosby, Inc. All rights reserved.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1

Figure 1

(online). Relationship between intrahepatic triglyceride (IHTG) content and indices of β-cell function and insulin sensitivity in lean adolescents and obese adolescents with and without nonalcoholic fatty liver disease (NAFLD). A) Global β-cell responsivity to oral glucose (Φo), B) insulin secretion adjusted for insulin sensitivity (disposition index, DI), C) insulin sensitivity index (ISI), and D) homeostasis model assessment of insulin resistance (HOMA-IR). Data are ranked. All relationships are statistically significant (P ≤ 0.001).

Figure 2

Figure 2

Cardiac function in lean adolescents and obese adolescents with and without nonalcoholic fatty liver disease (NAFLD). A) Left ventricular (LV) global strain, B) LV longitudinal global strain rate in systole, and C) LV longitudinal global strain rate in early diastole. Values are means±SD (A, C) or medians with quartiles (B). * Value significantly different from value in obese subjects (P < 0.05), † value significantly different from value in obese subjects without NAFLD (P < 0.05).

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