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01.08.2015 | Original Article—Liver, Pancreas, and Biliary Tract

The association between retinal microvascular changes, metabolic risk factors, and liver histology in pediatric patients with non-alcoholic fatty liver disease (NAFLD)

verfasst von: D. Liccardo, A. Mosca, S. Petroni, P. Valente, U. Giordano, A. G. A. Mico’, S. Pescosolido, L. Buzzonetti, Valerio Nobili

Erschienen in: Journal of Gastroenterology | Ausgabe 8/2015

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Abstract

Background

The prevalence of childhood obesity is increasing worldwide. Studies in adult populations show that retinal microvascular changes are associated with obesity and components of the metabolic syndrome. In our study we have assessed the effect of body mass index (BMI), metabolic parameters, and adiposity on the retinal microvasculature in children.

Methods

Fifty-four consecutive children with biopsy-proven NAFLD were enrolled in this study. Anthropometric and laboratory parameters were obtained using standardized protocols. Retinal caliber was quantified from digital retinal images using well-known computer-based programs. Twenty-four-hour ambulatory blood pressure monitoring was measured using a standard protocol.

Results

In our population, the prevalence of retinopathy was of 53 % (13 males). The 29 patients with retinopathy (mean age 10.91 ± 3.10) showed significantly higher values of triglycerides (mg/day) (105.57 vs. 90.20, p = 0.04), basal insulin (mUI/ml) (17.20 vs. 12.97, p = 0.02), and HOMA-IR (3.37 vs. 2.76, p = 0.04). The patients with a HOMA-IR >2.5 (OR = 3.34, p = 0.02; 95 % IC, 1.07–10.39), and systolic non-dipping (OR 4.16, p = 0.028, 95 % IC, 1.11–13.67), have an increased risk of retinopathy. Moreover, the study of correlation between all stages of liver biopsy (CRN criteria) and the grade of retinopathy showed a positive correlation with fibrosis (r = 0.31) and an NAS score (r = 0.28).

Conclusions

We found an association between metabolic parameters and nocturnal blood pressure on the retinal microvasculature among the obese children with NAFLD. Furthermore, for the first time, we report the positive relationship between hepatic fibrosis in pediatric NAFLD patients and the degree of retinopathy signs.

Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet. 2002;360:473–82.PubMedCrossRef

Gopinath B, Baur LA, Teber E, et al. Effect of obesity on retinal vascular structure in pre-adolescent children. Int J Pediatr Obes. 2011;6(2–2):e353–9.PubMedCrossRef

Adams LA, Lindor KD. Nonalcoholic fatty liver disease. Ann Epidemiol. 2007;17(11):863–9.PubMedCrossRef

Brunt EM. Pathology of nonalcoholic fatty liver disease. Nat Rev Gastroenterol Hepatol. 2010;7(4):195–203.PubMedCrossRef

Vajro P, Lenta S, Socha P, Dhawan A, McKiernan P, et al. Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr. 2012;54:700–13.PubMedCrossRef

Schwimmer JB, Behling C, Newbury R, et al. Histopathology of pediatric nonalcoholic fatty liver disease. Hepatology. 2005;42:641–9.PubMedCrossRef

Hübscher SG. Histological assessment of non-alcoholic fatty liver disease. Histopathology. 2006;49:450–65.PubMedCrossRef

Brunt EM, Janney CG, Di Bisceglie AM, et al. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94:2467–74.PubMedCrossRef

Kleiner DE, Brunt EM, van Natta M, et al. Design and validation of a histological scoring system for non-alcoholic fatty liver disease. Hepatology. 2005;41:1313–21.PubMedCrossRef

10.

Nobili V, Svegliati-Baroni G, Alisi A, et al. A 360-degree overview of paediatric NAFLD: recent insights. J Hepatol. 2013;58(6):1218–29.PubMedCrossRef

11.

Alisi A, Cianfarani S, Manco M, Agostoni C, Nobili V. Non-alcoholic fatty liver disease and metabolic syndrome in adolescents: pathogenetic role of genetic background and intrauterine environment. Ann Med. 2012;44(1):29–40.PubMedCrossRef

12.

Sundaram SS, Zeitler P, Nadeau K. The metabolic syndrome and non-alcoholic fatty liver disease in children. Curr Opin Pediatr. 2009;21:529–35.PubMedCentralPubMedCrossRef

13.

Alisi A, Nobili V. Overlapping clinical features between NAFLD and metabolic syndrome in children. EMJ Hepatol. 2014;1:55–61.

14.

Pacifico L, Nobili V, Anania C, Verdecchia P, Chiesa C. Pediatric non-alcoholic fatty liver disease metabolic syndrome and cardiovascular risk. World J Gastroenterol. 2011;17(26):3082–91.PubMedCentralPubMed

15.

Wong TY, Barr EL, Tapp RJ, Harper CA, Taylor HR, Zimmet PZ, Shaw JE, et al. Retinopathy in persons with impaired glucose metabolism: the Australian Diabetes Obesity and Lifestyle (AusDiab) study. Am J Ophthalmol. 2005;140:1157–9.PubMedCrossRef

16.

Wong TY, Klein R, Islam FM, et al. Three-year incidence and cumulative prevalence of retinopathy: the Atherosclerosis Risk in Communities study. Am J Ophthalmol. 2007;143:970–6.PubMedCentralPubMedCrossRef

17.

Cheung N, Saw SM, Islam FM, et al. BMI and retinal vascular caliber in children. Obesity Silver Spring. 2007;15(1):209–15.PubMedCrossRef

18.

Wang JJ, Taylor B, Wong TY, et al. Retinal vessel diameters and obesity: a population-based study in older persons. Obesity (Silver Spring). 2006;14(2):206–14.CrossRef

19.

Shore AC, Tooke JE. Microvascular function in human essential hypertension. J Hypertens. 1994;12:717–28.PubMedCrossRef

20.

Noon JP, Walker BR, Webb DJ, et al. Impaired microvascular dilatation and capillary rarefaction in young adults with a predisposition to high blood pressure. J Clin Invest. 1997;99:1873–9.PubMedCentralPubMedCrossRef

21.

Antonios TF, Singer DR, Markandu ND, et al. Rarefaction of skin capillaries in borderline essential hypertension suggests an early structural abnormality. Hypertension. 1999;34:655–8.PubMedCrossRef

22.

Levy BI, Ambrosio G, Pries AR, Struijker-Boudier HA. Microcirculation in hypertension: a new target for treatment? Circulation. 2001;104:735–40.PubMedCrossRef

23.

Yu T, Mitchell P, Berry G, et al. Retinopathy in older persons without diabetes and its relationship to hypertension. Arch Ophthalmol. 1998;16:83–9.CrossRef

24.

Wong TY, Klein R, Sharrett AR, et al. The prevalence and risk factors of retinal microvascular abnormalities in older persons: the Cardiovascular Health Study. Ophthalmology. 2003;110:658–66.PubMedCrossRef

25.

Klein R, Klein BE, Moss SE, et al. Hypertension and retinopathy, arteriolar narrowing, and arteriovenous nicking in a population. Arch Ophthalmol. 1994;112:92–8.PubMedCrossRef

26.

Keith NM, Wagener HP, Barker NW. Some different types of essential hypertension: their course and prognosis. Am J Med Sci. 1939;197:332–43.CrossRef

27.

Wong TY, Mitchell P. Hypertensive retinopathy. N Engl J Med. 2004;351:2310–7.PubMedCrossRef

28.

Katsi V, Vlachopoulos C, Souretis G, et al. Association between retinal microcirculation and aortic stiffness in hypertensive patients. Int J Cardiol. 2012;157(3):370–3.PubMedCrossRef

29.

Leung H, Wang JJ, Rochtchina E, et al. Relationships between age, blood pressure, and retinal vessel diameters in an older population. Invest Ophthalmol Vis Sci. 2003;44(7):2900–4.PubMedCrossRef

30.

Diabetes Prevention Program Research Group. The prevalence of retinopathy in impaired glucose tolerance and recent-onset diabetes in the Diabetes Prevention Program. Diabetes Med. 2007;24:137–44.CrossRef

31.

Kawasaki R, Wang JJ, Rochtchina E, et al. Cardiovascular risk factors and retinal microvascular signs in an adult Japanese population: the Funagata Study. Ophthalmology. 2006;13:1378–84.CrossRef

32.

van Leiden HA, Dekker JM, Moll AC, et al. Blood pressure, lipids, and obesity are associated with retinopathy: the Hoorn Study. Diabetes Care. 2002;25:1320–5.PubMedCrossRef

33.

De Jongh RT, Serne EH, IJzerman RG, et al. Impaired microvascular function in obesity: implications for obesity-associated microangiopathy, hypertension, and insulin resistance. Circulation. 2004;109:2529–35.PubMedCrossRef

34.

Daniels SR, Lipman MJ, Burke MJ, Loggie JM. The prevalence of retinal vascular abnormalities in children and adolescents with essential hypertension. Am J Ophthalmol. 1991;111:205–8.PubMedCrossRef

35.

Skalina ME, Annable WL, Kliegman RM, Fanaroff AA. Hypertensive retinopathy in the newborn infant. J Pediatr. 1983;103:781–6.PubMedCrossRef

36.

Băloşeanu CL, Streba CT, Vere CC, Comănescu V, Rogoveanu I. Association between liver histology, carotid ultrasonography and retinal vascular changes in patients with nonalcoholic fatty liver disease (NAFLD). Rom J Morphol Embryol. 2012;53(3):609–14.PubMed

37.

Centers for Disease Control and Prevention. About BMI for children and teens [cited 2013 Jul 13]. Available http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html.

38.

Cole TJ, Freeman JV, Preece MA. Body mass index reference curves for the UK, 1990. Arch Dis Childhood. 1995;73:25–9.CrossRef

39.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–9.PubMedCrossRef

40.

Giordano U, Della CC, Cafiero G, et al. Association between nocturnal blood pressure dipping and insulin resistance in children affected by NAFLD. Eur J Pediatr. 2014;173(11):1511–8.PubMedCrossRef

41.

Taarnhoj NCBB, Munch IC, Sander B, et al. Straight versus tortuous retinal arteries in relation to blood pressure and genetics. Br J Ophthalmol. 2008;92:1055–60.PubMedCrossRef

42.

Wilkinson CP, Ferris FL, Klein RE, et al. Global diabetic retinopathy project group. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003;110:1677–82.PubMedCrossRef

43.

Brunner EJ, Shipley MJ, Witte DR, et al. Relation between blood glucose and coronary mortality over 33 years in the Whitehall Study. Diabetes Care. 2006;29:26–31.PubMedCrossRef

44.

Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria: the DECODE study group: European Diabetes Epidemiology Group: Diabetes Epidemiology: Collaborative analysis of diagnostic criteria in Europe. Lancet. 1999;354:617–21.

45.

Gu D, Wildman RP, Wu X, et al. Incidence and predictors of hypertension over 8 years among Chinese men and women. J Hypertens. 2007;25:517–23.PubMedCrossRef

46.

Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289:2560–72.PubMedCrossRef

47.

Targher G, Bertolini L, Padovani R, et al. Relation of nonalcoholic hepatic steatosis to early carotid atherosclerosis in healthy men: role of visceral fat accumulation. Diabetes Care. 2004;27(10):2498–500.PubMedCrossRef

48.

Targher G, Bertolini L, Padovani R, et al. Associations between liver histology and carotid intima-media thickness in patients with nonalcoholic fatty liver disease. Arterioscler Thromb Vasc Biol. 2005;25(12):2687–8.PubMedCrossRef

49.

Nguyen TT, Wang JJ, Wong TY. Retinal vascular changes in pre-diabetes and prehypertension: new findings and their research and clinical implications. Diabetes Care. 2007;30(10):2708–15.PubMedCrossRef

50.

Wong TY, Mitchell P. The eye in hypertension. Lancet. 2007;369(9559):425–35.PubMedCrossRef

51.

Gopinath B, Baur LA, Wang JJ, et al. Blood pressure is associated with retinal vessel signs in preadolescent children. J Hypertens. 2010;28(7):1406–12.PubMedCrossRef

52.

Manco M, et al. Intima-media thickness and liver histology in obese children and adolescents with non-alcoholic fatty liver disease. Atherosclerosis. 2010;209:463–8.PubMedCrossRef

Titel: The association between retinal microvascular changes, metabolic risk factors, and liver histology in pediatric patients with non-alcoholic fatty liver disease (NAFLD)
verfasst von: D. Liccardo
A. Mosca
S. Petroni
P. Valente
U. Giordano
A. G. A. Mico’
S. Pescosolido
L. Buzzonetti
Valerio Nobili
Publikationsdatum: 01.08.2015
Verlag: Springer Japan
Erschienen in: Journal of Gastroenterology / Ausgabe 8/2015
Print ISSN: 0944-1174
Elektronische ISSN: 1435-5922
DOI: https://doi.org/10.1007/s00535-014-1024-1

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Abstract

Background

Methods

Results

Conclusions

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