Introduction
Material and methods
Study design and population
Study measurements
Hepatic markers
Statistical analysis
Results
Characteristics of the study population
Boys | Girls | p-value | Overweight | Obese | p-value | Early childhood (2–6 years old) | Middle childhood (7–12 years old) | Adolescence (13–18 years old) | p-value | |
---|---|---|---|---|---|---|---|---|---|---|
400 | 454 | 181 | 662 | 69 | 428 | 345 | ||||
General characteristics | ||||||||||
Age (years) | 11.9 (9.8, 14.3) | 12.1 (9.4, 15.5) | 0.1287 | 11.8 (10.1, 14.0) | 12.1 (9.5, 15.0) | 0.5170 | 5.5 (4.5, 6.3) | 10.6 (9.2, 11.7) | 15.3 (14.2, 16.4) | < 0.001 |
Sex (%) | - | 0.1701 | 0.981 | |||||||
Female | - | - | 58.01 | 52.27 | 53.62 | 50.00 | 56.81 | |||
Male | - | - | 41.99 | 47.73 | 46.38 | 50.00 | 43.19 | |||
Body composition | ||||||||||
Weight (kg) | 68.0 (52.2, 89.9) | 69.4 (48.1, 91.0) | 0.6433 | 56.1 (46.2, 67.9) | 72.2 (54.5, 95.8) | < 0.001 | 28.3 (25.9, 33.5) | 57.2 (47.0, 69.0) | 93.1 (80.7, 108.6) | < 0.001 |
Height (m) | 1.6 (1.4, 1.7) | 1.6 (1.4, 1.6) | 0.0473 | 1.5 (1.4, 1.6) | 1.6 (1.4, 1.7) | 0.0121 | 1.2 (1.1, 1.2) | 1.5 (1.4, 1.6) | 1.7 (1.6, 1.7) | < 0.001 |
BMI (kg/m2) | 28.0 (24.8, 32.7) | 28.7 (24.5, 33.5) | 0.5492 | 24.3 (22.5, 26.2) | 30.1 (26.3, 34.6) | < 0.001 | 21.3 (20.4, 22.9) | 26.3 (23.7, 29.3) | 33.3 (29.5, 37.5) | < 0.001 |
BMI z-score | 3.5 (3.0, 4.0) | 3.1 (2.7, 3.6) | < 0.001 | 2.4 (2.2, 2.6) | 3.5 (3.1, 4.0) | < 0.001 | 3.5 (2.8, 4.1) | 3.1 (2.7, 3.6) | 3.4 (2.9, 3.9) | < 0.001 |
Waist circumference (cm) | 93.0 (82.5, 105.0) | 89.2 (80.0, 102.8) | 0.0386 | 82.0 (75.9, 88.0) | 95.0 (85.0, 107.5) | < 0.001 | 68.0 (62.5, 72.2) | 86.4 (79.0, 94.0) | 104.0 (93.1, 112.7) | < 0.001 |
Waist circumference z-score | 5.4 (4.1, 7.2) | 4.8 (3.7, 6.7) | 0.0016 | 3.5 (2.6, 4.3) | 5.7 (4.4, 7.5) | < 0.001 | 3.7 (2.8, 4.5) | 4.4 (3.4, 5.6) | 6.9 (5.1, 8.1) | < 0.001 |
Hip circumference (cm) | 99.0 (88.8, 10.5) | 103.0 (87.0, 116.5) | 0.0514 | 91.4 (83.0, 99.3) | 105.0 (92.0, 117.3) | < 0.001 | 72.1 (68.0, 78.0) | 94.0 (85.0, 101.0) | 114.5 (106.0, 123.0) | < 0.001 |
Waist-to-hip ratio (WHr) | 0.9 (0.9, 1.0) | 0.9 (0.8, 1.0) | < 0.001 | 0.9 (0.8, 1.0) | 0.9 (0.9, 1.0) | < 0.001 | 0.9 (0.9, 1.0) | 0.9 (0.9, 1.0) | 0.9 (0.8, 1.0) | < 0.001 |
Neck circumference (cm) | 34.0 (31.1, 36.8) | 35.0 (32.5, 38.0) | < 0.001 | 32.5 (30.5, 34.5) | 35.1 (32.5, 38.3) | < 0.001 | 29.5 (27.5, 30.5) | 33.0 (31.3, 35.0) | 37.3 (35.0, 40.1) | < 0.001 |
Thigh circumference (cm) | 55.0 (48.0, 62.3) | 53.2 (47.8, 59.9) | 0.1125 | 50.0 (45.0, 54.0) | 57.0 (49.8, 63.6) | < 0.001 | 40.0 (37.0, 43.3) | 50.5 (47.0, 55.0) | 62.0 (57.5, 67.6) | < 0.001 |
Body fat distribution (%) | 0.7837 | 0.0025 | 0.0296 | |||||||
Normal | 56.7 | 61.7 | 69.8 | 56.4 | 66.2 | 60.6 | 56.2 | |||
Apple | 41.6 | 27.6 | 24.9 | 36.9 | 33.8 | 37.0 | 31.1 | |||
Pear | 1.7 | 10.7 | 5.3 | 6.7 | 0.0 | 2.4 | 12.7 | |||
Lifestyle factors | ||||||||||
Sleep time during week (hours/day) | 9.5 (8.5, 10.4) | 9.5 (8.5, 10.5) | 0.6965 | 10.0 (9.0, 10.5) | 9.5 (8.0, 10.5) | 0.0199 | 11.0 (10.5, 11.5) | 10.0 (9.5, 10.5) | 8.25 (7.5, 9.0) | < 0.001 |
Sweet drinks (glasses/day) | 2.0 (1.0, 4.0) | 2.0 (1.0, 4.0) | 0.6395 | 2.0 (0.5, 3.0) | 2.0 (1.0, 4.0) | 0.1243 | 1.5 (0.5, 3.0) | 2.0 (1.0, 4.0) | 2.0 (1.0, 4.0) | 0.1293 |
Screen time (hours/day) | 3.0 (2.0, 4.0) | 3.0 (1.5, 4.0) | 0.0150 | 3.0 (1.8, 4.0) | 3.0 (2.0, 4.5) | 0.2617 | 1.5 (1.0, 2.0) | 2.5 (1.5, 4.0) | 4.0 (2.5, 5.0) | < 0.001 |
Sport (%) | 46.7 | 53.3 | 0.8414 | 25.5 | 74.1 | 0.0007 | 7.6 | 55.6 | 36.8 | 0.0022 |
Boys | Girls | p-value | Overweight | Obese | p-value | Early childhood (2–6 years old) | Middle childhood (7–12 years old) | Adolescence (13–18 years old) | p-value | |
---|---|---|---|---|---|---|---|---|---|---|
n | 400 | 454 | 181 | 662 | 69 | 428 | 345 | |||
Clinical and blood biochemical markers | ||||||||||
SBP (mmHg) | 116.0 (110.0, 124.0) | 117.0 (111.0, 123.0) | 0.7720 | 113.0 (108.0, 121.0) | 118.0 (111.9, 124.0) | < 0.001 | 110.0 (102.5, 115.5) | 114.0 (109.0, 120.0) | 120.0 (114.0, 128.0) | < 0.001 |
DBP (mmHg) | 68.0 (63.0, 72.0) | 68.0 (63.0, 73.3) | 0.1334 | 68.0 (62.0, 72.0) | 68.0 (63.0, 73.0) | 0.0948 | 64.5 (60.0, 69.0) | 67.0 (62.0, 71.0) | 70.0 (65.0, 75.0) | < 0.001 |
Glucose (mg/dl) | 79.3 (72.1, 88.3) | 77.5 (70.3, 86.5) | 0.0170 | 81.1 (72.1, 88.3) | 77.5 (70.3, 86.5) | 0.1327 | 80.2 (73.9, 88.3) | 79.3 (71.2, 88.3) | 77.5 (72.1, 86.5) | 0.6119 |
HOMA-IR | 2.1 (0.7, 3.9) | 2.4 (1.0, 4.0) | 0.2110 | 1.8 (1.0, 3.2) | 2.4 (0.8, 4.2) | 0.0133 | 0.4 (0.0, 1.6) | 1.9 (0.8, 3.6) | 2.9 (1.7, 5.0) | < 0.001 |
Total cholesterol (mg/dl) | 158.3 (139.0, 177.6) | 162.2 (142.0, 185.3) | 0.1601 | 158.3 (142.9, 175.7) | 162.2 (142.9, 181.5) | 0.2215 | 158.3 (142.9, 173.7) | 162.2 (142.9, 185.3) | 158.3 (139.0, 177.6) | 0.1078 |
LDL-c (mg/dl) | 92.7 (73.4, 108.1) | 92.7 (77.2, 112.0) | 0.3255 | 88.8 (73.4, 108.1) | 92.7 (77.2, 112.0) | 0.0157 | 88.8 (81.1, 104.2) | 92.7 (77.2, 112.0) | 88.8 (73.4, 112.0) | 0.3437 |
HDL-c (mg/dl) | 46.3 (42.5, 54.1) | 46.2 (42.5, 54.1) | 0.7123 | 50.2 (42.5, 57.9) | 46.3 (38.6, 54.1) | < 0.001 | 54.1 (46.3, 61.8) | 50.2 (42.5, 57.9) | 46.3 (38.6, 54.1) | < 0.001 |
TG (mgdl) | 85.0 (60.2, 115.0) | 88.5 (64.6, 119.5) | 0.1792 | 84.8 (58.0, 111.1) | 86.7 (63.7, 119.5) | 0.1004 | 62.8 (46.0, 86.7) | 87.6 (61.9, 115.9) | 89.8 (66.4, 126.5) | < 0.001 |
TyG (md/dl) | 8.1 (7.8, 8.5) | 8.1 (7.8, 8.5) | 0.5968 | 8.1 (7.7, 8.4) | 8.1 (8.0, 8.5) | 0.3111 | 7.8 (7.5, 8.2) | 8.1 (7.8, 8.5) | 8.2 (7.8, 8.5) | < 0.001 |
ALT (U/L) | 23.0 (21.0, 30.0) | 22.0 (17.0, 30.0) | 0.4919 | 22.0 (18.0, 29.5) | 22.0 (17.0, 30.0) | 0.7535 | 22.0 (17.0, 28.0) | 22.0 (17.0, 30.0) | 22.0 (18.0, 31.0) | 0.7697 |
AST (U/L) | 25.0 (21.0, 31.0) | 26.0 (20.0, 32.0) | 0.7854 | 26.0 (21.0, 32.0) | 26.0 (20.0, 31.0) | 0.2466 | 26.5 (22.0, 33.0) | 25.0 (20.0, 31.0) | 26.0 (21.0, 32.0) | 0.3368 |
GGT (U/L) | 16.0 (13.0, 21.0) | 17.0 (13.0, 21.0) | 0.9156 | 15.0 (12.0, 20.0) | 17.0 (13.0, 21.0) | 0.0277 | 15.0 (12.0, 20.0) | 16.0 (13.0, 21.0) | 17.0 (13.0, 21.0) | 0.1649 |
Insulin (mU/L) | 15.3 (8.9, 22.7) | 13.5 (8.1, 21.7) | 0.0843 | 12.7 (6.9, 21.7) | 14.6 (8.9, 22.2) | 0.0684 | 11.5 (6.9, 17.8) | 14.4 (8.9, 23.3) | 14.6 (8.4, 21.7) | 0.0788 |
CRP (mg/L) | 2.0 (1.0, 5.0) | 2.0 (2.0, 5.0) | 0.0289 | 1.0 (1.0, 3.0) | 2.0 (1.0, 5.0) | < 0.001 | 2.0 (1.0, 3.0) | 2.0 (1.0, 4.0) | 2.0 (1.0, 6.0) | 0.0015 |
HbA1C (%) | 5.2 (5.0, 5.5) | 5.3 (5.0, 5.5) | 0.1055 | 5.2 (5.0, 5.5) | 5.2 (5.0, 5.4) | 0.3029 | 5.2 (4.9, 5.4) | 5.2 (5.0, 5.5) | 5.2 (5.0, 5.5) | 0.3771 |
Platelets (109/L) | 310 (267, 352) | 302(261, 348) | 0.6871 | 312 (262, 349) | 302 (263, 351) | 0.6068 | 324.5 (269, 353.5) | 306 (261, 353) | 300 (264, 345.5) | 0.7286 |
FFA (mmol/L) | 0.7 (0.5, 0.8) | 0.7 (0.5, 0.8) | 0.5817 | 0.7 (0.5, 0.9) | 0.7 (0.5, 0.8) | 0.2034 | 0.7 (0.5, 0.9) | 0.7 (0.5, 0.8) | 0.7 (0.5, 0.8) | 0.9645 |
Alkaline phosphatase (U/L) | 233.5 (147.0, 303.0) | 237.0 (139.0, 304.5) | 0.9971 | 241.0 (143.0, 302.0) | 235.0 (146.0, 304.0) | 0.7792 | 243.5 (152.0, 315.0) | 232.0 (139.0, 300.0) | 235.0 (140.0, 306.0) | 0.7590 |
Bilirubin (µmol/L) | 6.4 (4.7, 8.9) | 6.7 (4.9, 9.3) | 0.2255 | 6.6 (4.9, 8.9) | 6.5 (4.7, 9.2) | 0.5293 | 6.0 (4.2, 8.2) | 6.6 (4.9, 9.4) | 6.4 (4.8, 9.2) | 0.2308 |
Hepatic markers
Overweight | Obese | p-value | |
---|---|---|---|
n | 181 | 662 | |
Hepatic markers | |||
Waist-to-height ratio (WHtR) | 0.5 (0.5, 0.6) | 0.6 (0.6, 0.7) | < 0.001 |
Visceral adiposity index (VAI) | 2.5 (1.6, 3.9) | 2.9 (1.8, 4.6) | 0.0053 |
Triglyceride-glucose index (TyG) | 8.1 (7.7, 8.4) | 8.1 (8.0, 8.5) | 0.3111 |
Hypertriglyceridemic-waist index (WC*TyG) | 660.9 (603.3, 734.7) | 771.3 (681.9, 881.4) | < 0.001 |
Lipid accumulation product (LAP) | 17.6 (9.8, 30.1) | 30.5 (16.6, 53.8) | < 0.001 |
Fatty liver index (FLI) | 0.5 (0.3, 0.9) | 2.1 (0.7, 7.5) | < 0.001 |
Hepatic steatosis index (HSI) | 34.1 (32.3, 36.2) | 40.0 (35.9, 44.6) | < 0.001 |
Zhejiang University Index (ZJU) | 33.8 (31.4, 36.2) | 39.4 (35.3, 44.4) | < 0.001 |
Fibrosis-4 (FIB-4) | 0.2 (0.2, 0.3) | 0.2 (0.1, 0.3) | 0.5963 |
AST to platelet ratio index (APRI) | 0.2 (0.2, 0.3) | 0.2 (0.2, 0.3) | 0.1443 |
FORNS index | −1.5 (−2.4, −0.8) | −1.5 (−2.5, −0.5) | 0.5663 |
NAFLD fibrosis score (NFS) | −28.8 (−30.2, −27.2) | −28.2 (−30.0, −26.5) | 0.0633 |
FibroMeter | 18.0 (17.1, 18.7) | 18.7 (17.5, 20.1) | < 0.001 |
Pediatric NAFLD Fibrosis Index (PNFI) | 2.5 (0.6, 5.8) | 1.8 (0.3, 5.7) | 0.2731 |
Pediatric NAFLD Fibrosis Score (PNFS) | 31.6 (25.8, 37.9) | 30.6 (24.4, 37.6) | 0.3162 |
Pediatric metabolic index (PMI) | 0.1 (0.1, 0.1) | 0.2 (0.1, 0.2) | < 0.001 |
Relationship between liver damage and lifestyle factors
Liver damage (HSI) | |||
---|---|---|---|
β | p-value | R2 | |
Model 1 | < 0.001 | 0.4076 | |
Age (years) | 1.064 | < 0.001 | |
Screen time (h/day) | 0.406 | 0.002 | |
Sleep time (h/day) | −0.437 | 0.027 | |
Sweet drinks consumption (glasses/day) | 0.180 | 0.045 | |
Insulin (mU/L) | −0.001 | 0.945 | |
Model 2 | < 0.001 | 0.7864 | |
Age (years) | 0.498 | < 0.001 | |
Waist circumference (cm) | 0.198 | < 0.001 | |
WHR | −15.280 | < 0.001 | |
Sleep time (h/day) | 2.804 | < 0.001 | |
BMI z-score | 11.627 | < 0.001 | |
Sleep time # BMI z-score | −0.846 | < 0.001 |