Int J Clin Pediatr

International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access

Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc

Journal website http://www.theijcp.org

Original Article

Volume 4, Number 4, December 2015, pages 171-177

Steatosis and Insulin Resistance: Prevalence and Association With Cardiovascular Risk in Obese Adolescents

**Table 1.** Characterization of the Population: Nutritional Status and Body Composition (InBody^®), Biochemical Parameters (Glucose Metabolism and Hepatic and Lipidic Profiles) and Systolic and Diastolic Blood Pressure From All the Population and According to Gender
	Total (n = 184)	Male (n = 77)	Female (n = 107)	P
BMI: body mass index; WtHR: weight-to-height ratio; HDL-c: high-density lipoprotein-cholesterol; TC: total cholesterol; LDL-c: low-density lipoprotein-cholesterol; AST: aspartate aminotransferase; ALT: alanine aminotrasferase. Data are expressed in average and standard deviation for variables with symmetric distribution and in median for variables with asymmetric distribution (†). In both cases, values of the first and third quartiles (25th percentile and 75th percentile, P25-P75) are presented. Statistical significant value for a level of significance of 5%. *Statistical significant value for a level of significance of 1%.
Chronologic age (years)	12.6 ± 1.9 (11.0 - 13.8)	12.4 ± 1.6 (11.1 - 13.5)	12.8 ± 2.1 (10.9 - 14.1)	0.158
BMI z score	2.29 ± 0.76 (1.78 - 2.68)	2.53 ± 0.79 (2.12 - 2.90)	2.12 ± 0.69 (1.64 - 2.53)	< 0.001**
Fat mass (%)	38.2 ± 7.7 (33.0 - 43.2)	37.0 ± 8.4 (31.3 - 42.9)	39.1 ± 7.0 (34.8 - 43.3)	0.089
Waist circumference (cm)	90.0 ± 11.4 (82.5 - 96.0)	92.1 ± 12.0 (83.5 - 97.0)	88.4 ± 10.4 (88.1 - 95.4)	0.041*
WtHR	0.59 ± 0.09 (0.54 - 0.61)	0.60 ± 0.10 (0.54 - 0.62)	0.59 ± 0.09 (0.54 - 0.61)	0.366
Glucose metabolism
Glucose (mg/dL)	85.1 ± 6.7 (81.0 - 89.0)	86.3 ± 5.7 (82.3 - 90.0)	84.1 ± 7.2 (80.0 - 88.0)	0.065
Insulin (μUI/mL)†	11.0 (7.0 - 15.7)	10.2 (6.5 - 17.0)	11.4 (7.1 - 15.3)	0.454
HOMA-IR†	2.24 (1.45 - 3.36)	2.27 (1.39 - 3.58)	2.23 (1.47 - 3.33)	0.847
Lipid profile
Total cholesterol (mg/dL)	166.2 ± 29.4 (144.0 - 186.0)	169.2 ± 29.5 (148.5 - 186.0)	164.0 ± 29.4 (142.0 - 186.8)	0.335
HDL-c (mg/dL)	49.1 ± 11.0 (41.0 - 56.0)	47.4 ± 10.2 (39.8 - 54.8)	50.2 ± 11.4 (41.0 - 56.5)	0.163
TC/HDL-c (mg/dL)	3.50 ± 0.81 (2.97 - 3.83)	3.68 ± 0.90 (3.14 - 4.23)	3.36 ± 0.73 (2.91 - 3.70)	0.034*
LDL-c (mg/dL)†	100.0 (83.0 - 116.3)	103.0 (81.5 - 118.0)	96.5 (83.0 - 116.3)	0.393
Triglycerides (mg/dL)†	67.0 (51.0 - 95.3)	70.0 (54.0 - 114.0)	67.0 (48.5 - 92.0)	0.882
Hepatic profile
AST/TGO (U/L)†	21.0 (18.0 - 26.0)	23.0 (19.0 - 29.0)	21.0 (17.0 - 24.3)	0.113
ALT/TGP (U/L)†	27.0 (19.0 - 38.0)	27.0 (21.0 - 42.0)	26.0 (17.0 - 35.0)	0.992
Blood pressure
Systolic (mm Hg)	119.5 ± 11.2 (112.0 - 126.0)	123.3 ± 12.0 (115.5 - 129.0)	116.3 ± 9.3 (110.0 - 121.0)	< 0.001**
Diastolic (mm Hg)	68.1 ± 10.5 (60.0 - 76.0)	68.6 ± 11.9 (58.0 - 77.0)	67.8 ± 9.1 (61.0 - 75.0)	0.585

Table 1. Characterization of the Population: Nutritional Status and Body Composition (InBody^®), Biochemical Parameters (Glucose Metabolism and Hepatic and Lipidic Profiles) and Systolic and Diastolic Blood Pressure From All the Population and According to Gender

Total (n = 184)

Male (n = 77)

Female (n = 107)

BMI: body mass index; WtHR: weight-to-height ratio; HDL-c: high-density lipoprotein-cholesterol; TC: total cholesterol; LDL-c: low-density lipoprotein-cholesterol; AST: aspartate aminotransferase; ALT: alanine aminotrasferase. Data are expressed in average and standard deviation for variables with symmetric distribution and in median for variables with asymmetric distribution (†). In both cases, values of the first and third quartiles (25th percentile and 75th percentile, P25-P75) are presented. *Statistical significant value for a level of significance of 5%. **Statistical significant value for a level of significance of 1%.

Chronologic age (years)

12.6 ± 1.9 (11.0 - 13.8)

12.4 ± 1.6 (11.1 - 13.5)

12.8 ± 2.1 (10.9 - 14.1)

0.158

BMI z score

2.29 ± 0.76 (1.78 - 2.68)

2.53 ± 0.79 (2.12 - 2.90)

2.12 ± 0.69 (1.64 - 2.53)

< 0.001**

Fat mass (%)

38.2 ± 7.7 (33.0 - 43.2)

37.0 ± 8.4 (31.3 - 42.9)

39.1 ± 7.0 (34.8 - 43.3)

0.089

Waist circumference (cm)

90.0 ± 11.4 (82.5 - 96.0)

92.1 ± 12.0 (83.5 - 97.0)

88.4 ± 10.4 (88.1 - 95.4)

0.041*

WtHR

0.59 ± 0.09 (0.54 - 0.61)

0.60 ± 0.10 (0.54 - 0.62)

0.59 ± 0.09 (0.54 - 0.61)

0.366

Glucose metabolism

Glucose (mg/dL)

85.1 ± 6.7 (81.0 - 89.0)

86.3 ± 5.7 (82.3 - 90.0)

84.1 ± 7.2 (80.0 - 88.0)

0.065

Insulin (μUI/mL)†

11.0 (7.0 - 15.7)

10.2 (6.5 - 17.0)

11.4 (7.1 - 15.3)

0.454

HOMA-IR†

2.24 (1.45 - 3.36)

2.27 (1.39 - 3.58)

2.23 (1.47 - 3.33)

0.847

Lipid profile

Total cholesterol (mg/dL)

166.2 ± 29.4 (144.0 - 186.0)

169.2 ± 29.5 (148.5 - 186.0)

164.0 ± 29.4 (142.0 - 186.8)

0.335

HDL-c (mg/dL)

49.1 ± 11.0 (41.0 - 56.0)

47.4 ± 10.2 (39.8 - 54.8)

50.2 ± 11.4 (41.0 - 56.5)

0.163

TC/HDL-c (mg/dL)

3.50 ± 0.81 (2.97 - 3.83)

3.68 ± 0.90 (3.14 - 4.23)

3.36 ± 0.73 (2.91 - 3.70)

0.034*

LDL-c (mg/dL)†

100.0 (83.0 - 116.3)

103.0 (81.5 - 118.0)

96.5 (83.0 - 116.3)

0.393

Triglycerides (mg/dL)†

67.0 (51.0 - 95.3)

70.0 (54.0 - 114.0)

67.0 (48.5 - 92.0)

0.882

Hepatic profile

AST/TGO (U/L)†

21.0 (18.0 - 26.0)

23.0 (19.0 - 29.0)

21.0 (17.0 - 24.3)

0.113

ALT/TGP (U/L)†

27.0 (19.0 - 38.0)

27.0 (21.0 - 42.0)

26.0 (17.0 - 35.0)

0.992

Blood pressure

Systolic (mm Hg)

119.5 ± 11.2 (112.0 - 126.0)

123.3 ± 12.0 (115.5 - 129.0)

116.3 ± 9.3 (110.0 - 121.0)

< 0.001**

Diastolic (mm Hg)

68.1 ± 10.5 (60.0 - 76.0)

68.6 ± 11.9 (58.0 - 77.0)

67.8 ± 9.1 (61.0 - 75.0)

0.585

**Table 2.** Prevalence of overweight and obesity (n = 184), of insulin resistance (n = 110) and of hepatic steatosis (n = 98), according to gender (n, %)
Gender	Overweight (z score IMC ≥ 1.0)	Obesity (z score IMC ≥ 2.0)	Insulin resistance (HOMA-IR > 2.60)	Hepatic steatosis (ultrasound)
F: female; M: male.
M	16/77 (20.8%)	61/77 (79.2%)	17/46 (37.0%)	17/40 (36.2%)
F	54/107 (50.5%)	53/107 (49.5%)	25/64 (39.1%)	15/58 (25.9%)
Total	70/184 (38.0%)	114/184 (62.0%)	42/110 (38.2%)	32/98 (32.7%)

Table 2. Prevalence of overweight and obesity (n = 184), of insulin resistance (n = 110) and of hepatic steatosis (n = 98), according to gender (n, %)

Gender

Overweight (z score IMC ≥ 1.0)

Obesity (z score IMC ≥ 2.0)

Insulin resistance (HOMA-IR > 2.60)

Hepatic steatosis (ultrasound)

F: female; M: male.

16/77 (20.8%)

61/77 (79.2%)

17/46 (37.0%)

17/40 (36.2%)

54/107 (50.5%)

53/107 (49.5%)

25/64 (39.1%)

15/58 (25.9%)

Total

70/184 (38.0%)

114/184 (62.0%)

42/110 (38.2%)

32/98 (32.7%)

**Table 3.** Independent Association Between the Presence of Insulin Resistance (HOMA-IR > 2.60) and Hepatic Steatosis (Assessment Through Ultrasound) and Cardiovascular Risk Factors (WtHR, Glucose Metabolism, Lipid Profile and Blood Pressure) Expressed by Higher Severity Risk Score: Multivariate Analysis (Analysis Adjusted to Gender and Chronologic Age)
Cardiovascular risk score	Insulin resistance	Hepatic steatosis
WtHR: waist-to-height ratio; DBP: diastolic blood pressure; SBP: systolic blood pressure. Statistically significant value for a significance level of 5%. *Statistically significant value for a significance level of 1%.
z score BMI ≥ 2.0	+ 4.111	0.128	+ 0.001	0.971
WtHR > 0.5	+ 6.814	0.033*	+ 0.840	0.359
Total cholesterol ≥ 200 mg/dL	+ 1.817	0.769	+ 0.614	0.736
HDL-c ≤ 35 mg/dL	+ 3.940	0.414	+ 8.951	0.011**
LDL-c ≥ 130 mg/dL	+ 6.507	0.164	+ 0.334	0.846
Triglycerides ≥ 150 mg/dL	+ 15.608	0.004**	+ 0.965	0.617
SBP > 95th percentile	+ 5.891	0.207	+ 2.181	0.336
DBP > 95th percentile	+ 1.656	0.799	+ 1.623	0.444
HOMA-IR > 2.60	n.a.	n.a	+ 0.665	0.717
Hepatic steatosis present	+ 0.665	0.717	n.a.	n.a

Table 3. Independent Association Between the Presence of Insulin Resistance (HOMA-IR > 2.60) and Hepatic Steatosis (Assessment Through Ultrasound) and Cardiovascular Risk Factors (WtHR, Glucose Metabolism, Lipid Profile and Blood Pressure) Expressed by Higher Severity Risk Score: Multivariate Analysis (Analysis Adjusted to Gender and Chronologic Age)

Cardiovascular risk score

Insulin resistance

Hepatic steatosis

Pearson Chi-square

WtHR: waist-to-height ratio; DBP: diastolic blood pressure; SBP: systolic blood pressure. *Statistically significant value for a significance level of 5%. **Statistically significant value for a significance level of 1%.

z score BMI ≥ 2.0

+ 4.111

0.128

+ 0.001

0.971

WtHR > 0.5

+ 6.814

0.033*

+ 0.840

0.359

Total cholesterol ≥ 200 mg/dL

+ 1.817

0.769

+ 0.614

0.736

HDL-c ≤ 35 mg/dL

+ 3.940

0.414

+ 8.951

0.011**

LDL-c ≥ 130 mg/dL

+ 6.507

0.164

+ 0.334

0.846

Triglycerides ≥ 150 mg/dL

+ 15.608

0.004**

+ 0.965

0.617

SBP > 95th percentile

+ 5.891

0.207

+ 2.181

0.336

DBP > 95th percentile

+ 1.656

0.799

+ 1.623

0.444

HOMA-IR > 2.60

n.a.

n.a

+ 0.665

0.717

Hepatic steatosis present

+ 0.665

0.717

n.a.

n.a

**Table 4.** CVRF Aggregation in the Total Population and by Gender, the Presence of Insulin Resistance and of Hepatic Steatosis
	CVRF
Data are presented in number of cases and respective percentage for the total of assessed cases. It was considered CVRF, regardless of the nutrition status, the following parameters: waist-to-height ratio > 0.5; total cholesterol ≥ 200 mg/dL; HDL-c ≤ 35 mg/dL; LDL-c ≥ 130 mg/dL; triglycerides ≥ 150 mg/dL; systolic or diastolic blood pressure > 95th percentile.
Population total (n = 184)	22 (12.0)	78 (42.4)	84 (45.7)
Male gender (n = 77)	7 (9.1)	30 (39.0)	40 (51.9)
Female gender (n = 107)	15 (14.0)	48 (44.9)	44 (41.1)
Steatosis (n = 32)	4 (12.5)	9 (28.1)	19 (59.4)
Insulin resistance (n = 42)	0	2 (4.8)	40 (95.2)
Steatosis + insulin resistance (n = 9)	0	0	9 (100.0)

Table 4. CVRF Aggregation in the Total Population and by Gender, the Presence of Insulin Resistance and of Hepatic Steatosis

CVRF

Without CVRF, n (%)

1 CVRF, n (%)

≥ 2 CVRF, n (%)

Data are presented in number of cases and respective percentage for the total of assessed cases. It was considered CVRF, regardless of the nutrition status, the following parameters: waist-to-height ratio > 0.5; total cholesterol ≥ 200 mg/dL; HDL-c ≤ 35 mg/dL; LDL-c ≥ 130 mg/dL; triglycerides ≥ 150 mg/dL; systolic or diastolic blood pressure > 95th percentile.

Population total (n = 184)

22 (12.0)

78 (42.4)

84 (45.7)

Male gender (n = 77)

7 (9.1)

30 (39.0)

40 (51.9)

Female gender (n = 107)

15 (14.0)

48 (44.9)

44 (41.1)

Steatosis (n = 32)

4 (12.5)

9 (28.1)

19 (59.4)

Insulin resistance (n = 42)

2 (4.8)

40 (95.2)

Steatosis + insulin resistance (n = 9)

9 (100.0)

**Table 5.** Probability (OR) and Relative Risk (RR) of the Presence of Cardiovascular Risk Factors (Glucose Metabolism, Lipidic Profile and Blood Pressure) Excluding Waist to Height Ratio, According to the presence of steatosis and Insulin Resistance
	Presence of two or more cardiovascular risk factors
*Statistically significant value.
Steatosis (n = 7)	0.188 (P = 0.665)	1.26 (0.44 - 3.58)	1.20 (0.52 - 2.76)
Insulin resistance (n = 12)	6.070 (P = 0.014*)	3.49 (1.25 - 9.76)*	2.77 (1.18 - 6.49)*
Steatosis and insulin resistance (n = 4)	3.255 (P = 0.071)	3.60 (0.84 - 15.44)	2.44 (1.00 - 5.96)
Steatosis or insulin resistance (n = 15)	3.934 (P = 0.047*)	2.61 (0.99 - 6.91)	2.24 (0.98 - 5.14)

Table 5. Probability (OR) and Relative Risk (RR) of the Presence of Cardiovascular Risk Factors (Glucose Metabolism, Lipidic Profile and Blood Pressure) Excluding Waist to Height Ratio, According to the presence of steatosis and Insulin Resistance

Presence of two or more cardiovascular risk factors

Chi-square (P-value)

OR (95% CI)

RR (95% CI)

*Statistically significant value.

Steatosis (n = 7)

0.188 (P = 0.665)

1.26 (0.44 - 3.58)

1.20 (0.52 - 2.76)

Insulin resistance (n = 12)

6.070 (P = 0.014*)

3.49 (1.25 - 9.76)*

2.77 (1.18 - 6.49)*

Steatosis and insulin resistance (n = 4)

3.255 (P = 0.071)

3.60 (0.84 - 15.44)

2.44 (1.00 - 5.96)

Steatosis or insulin resistance (n = 15)

3.934 (P = 0.047*)

2.61 (0.99 - 6.91)

2.24 (0.98 - 5.14)