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Early childhood obesity linked to higher metabolic risk in mid-childhood

Higher waist circumference in early childhood and higher adiposity measures from early to mid-childhood correlated with higher alanine aminotransferase levels in mid-childhood, according to a recently published study.

“Mirroring the high prevalence of childhood obesity, [nonalcoholic fatty liver disease (NAFLD)] is now the most common cause of chronic liver disease in children,” Jennifer A. Woo Baidal, MD, MPH, from the Columbia University Medical Center, New York, and colleagues wrote. “A variety of disease phenotypes for NAFLD exist, including simple steatosis and steatohepatitis; the hallmark of each is hepatic steatosis (fat infiltration of liver cells) without alternative causes. Long-term complications may include cirrhosis and hepatocellular carcinoma.”

Woo Baidal and colleagues performed a study of children in Project Viva, an ongoing prospective pre-birth cohort study. Of the 635 children included, 48% were girls, 59% were white, 21% were black, 6% were Hispanic, and 3% were Asian.

In mid-childhood, mean ALT was 20.3 units per liter and ALT levels were elevated in 20% of the boys and 27% of the girls.

Adjusted models showed that each unit increase in BMI z score from early to mid-childhood correlated with 1.66 units per liter (95% CI, 0.89-2.43) higher ALT in mid-childhood. Each centimeter increase in waist and hip circumference from early to mid-childhood correlated with 0.22 units per liter (95% CI, 0.13-0.32) and 0.3 units per liter (95% CI, 0.2-0.41) higher mid-childhood ALT, respectively.

Finally, the researchers found that higher early childhood waist circumference; higher mid-childhood BMI z score, skinfolds thickness, waist circumference and hip circumference; and greater increases from early to mid-childhood in BMI z score, skinfolds thickness, waist circumference and hip circumference correlated with a higher risk for elevated sex-specific ALT level in mid-childhood.

In a subanalysis of 527 children from the original cohort, the researchers also found that higher ALT units per liter correlated with higher metabolic risk scores (0.02 units; 95% CI, 0.01-0.02), higher systolic BP (0.13 mm Hg; 95% CI, 0.04-0.22), higher homeostatic model assessment of insulin resistance (0.05 units; 95% CI, 0.03-0.07), and higher fasting insulin (0.16 U/mL; 95% CI, 0.09-0.23), which remained significant after attenuating for BMI z score.

“Our findings suggest that the time between early and mid-childhood is an important period in the prevention of obesity complications, including elevated ALT levels and insulin resistance,” the researchers wrote. “Early childhood should be targeted in future interventions to identify approaches to prevent pediatric obesity, liver disease, and related metabolic risk.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.