Evaluation of hepatic fibrosis in childhood obesity-related fatty liver disease by non-invasive methods

It was aimed to show whether the fibrosis score, which can be detected by shear wave elastography, APRI and FIB-4 scoring, is an independent indicator of steatohepatitis in children and adolescents with obesity-related fatty liver disease, and to reveal whether wrist circumference measurement is a risk factor for steatohepatitis in obese patients. For this purpose, 50 patients with obesity and 16 control with normal BMI without liver-related disease, a total of 66 people were included in the study. 50 patients with obesity were grouped as NASH, simple steatosis, and obesity only, according to USG findings and transaminase values. SWE measurements, APRI and FIB-4 scores and wrist circumference of the patients were evaluated. The median SWE value was 9.4 (7.4-11.9) in the NASH group, 8.7 (7.2- 10.75) in those with simple steatosis, 11.6 (7-14.1) in those with only obesity, and 6.75 (6.5-7.5) in the control group. While no significant difference was found in terms of steatozis/NASH in SWE results, it was observed that the results were associated with obesity. The difference between the groups in the FIB4 score was not statistically significant (p=0.089). In the NASH group, the median APRI score was 0.32 (IQR: 0.28-0.46), simple steatosis was 0.1 (IQR: 0.1-0.2), and 0.2 (IQR: 0.1- 0.2) without NAFLD and 0.19 (IQR: 0.16-0.25) in the control group (p<0.001). The mean wrist circumference was highest in NASH (18.78±1.79 cm) and lowest in the control group (p<0.001). Wrist circumference of patients with NASH was found to be higher (17.19±1.68 cm) than those with simple steatosis. (p<0.005)As a result, The frequency of NASH in children with obesity is closely related to high BMI, waist circumference and wrist circumference. Elastography measurements were not associated with steatozis and NASH development. Since variable results have been reported in patients with obesity, it should be evaluated with larger studies before using it in patient follow-up. Wrist circumference was found to be a risk factor for NASH. Since our study is the first to examine the relationship between wrist circumference and NASH, it should be supported by studies involving a large patient group. Keywords: NAFLD, NASH, elastography, wrist circumference