New criteria in defining the metabolic syndrome in children – an analysis of the relationship between the hepatic enzymes and the insulin resistance, HOMA-IR, glucose tolerance test in the obese children

Main Article Content

Ana-Maria Pelin
Gabriela Balan
Cristina Stefanescu
Stefan Rosca
Camelia Busila


KEYWORDS: obesity, child, glucose tolerance decrease, hepatic enzymes


Method: 108 children aged between 7 and 18 years old (12.89±2.93), with body mass index - BMI > 25 kg/m2 were studied, who underwent metabolic syndrome parameters’ assessments. Determinations of blood pressure, abdominal perimeter, fasting glucose, OGTT (oral glucose tolerance test -2-h G), insulinemia were made, the HOMA-IR index (Homeostatic model assessment for insulin resistance) was calculated. The value of the HOMA-IR index between 2-4 was considered as glucose tolerance decrease and HOMA-IR>4 was considered diabetes for both sexes. We also made laboratory determinations of cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides. We correlated the identified groups with diabetes mellitus and the glucose tolerance decrease according to HOMA-IR and OGTT with the values of liver enzymes AST (aspartataminotransferase) and ALT (alaninaminotransferase).

Results: The calculated HOMA-IR showed, in 53.7% of the obese children, the glucose tolerance decrease, (HOMA-IR > 2). The individual level of the HOMA-IR index was significantly lower at older ages, the correlation was indirect, moderate in intensity (r = - 0.217; p=0.024), suggesting that approximately 22% of children have a lower HOMA-IR level at older ages. The following are confirmed as good predictors of diabetes: LDL cholesterol (AUC=0.632; IC95%: 0.526-0.738; p=0.018), ALT (AUC=0.645; IC95%: 0.541-0.750; p=0.009) and AST (AUC=0.617; IC95%: 0.510-0.724; p=0.036). The HDL cholesterol parameter proves to be a good predictor of decreased glucose tolerance (AUC=0.607; IC95%: 0.469-0.745)

Conclusions: The increased liver enzymes (mainly AST, but also ALT) and LDL cholesterol are positively associated with the prevalence of the metabolic syndrome (MS) in paediatric populations and with diabetes mellitus. Although there is a correlation between AST, ALT and LDL-cholesterol and decreased glucose tolerance or diabetes mellitus, a larger batch analysis of obese children is required to determine whether liver enzymes and LDL-cholesterol can be introduced as diagnostic criteria of the MS.

KEYWORDS: obesity, child, glucose tolerance decrease, hepatic enzymes


Download data is not yet available.
Abstract 88 | PDF Downloads 56


1. Duijts L, Vernooij MW, Gaillard R, Jaddoe VWV. Liver Fat and Cardiometabolic Risk Factors Among School-Age Children. Hepatology. 2020; 72: 119–129.
2.Mann JP, Valenti L, Scorletti E, Byrne CD, Nobili V. Nonalcoholic Fatty Liver Disease in Children. Semin Liver Dis. 2018 Feb;38(1):1-13. doi: 10.1055/s-0038-1627456. Epub 2018 Feb 22. PMID: 29471561.
3.Gaggini M, Morelli M, Buzzigoli E, DeFronzo RA, Bugianesi E, Gastaldelli A. Non-alcoholic fatty liver disease (NAFLD) and its connection with insulin resistance, dyslipidemia, atherosclerosis and coronary heart disease. Nutrients 2013;5(05): 1544–1560
4. Valenti L, Bugianesi E, Pajvani U, Targher G. Nonalcoholic fatty liver disease: cause or consequence of type 2 diabetes? Liver Int 2016;36(11):1563–1579
5. DeBoer MD. Assessing and Managing the Metabolic Syndrome in Children and Adolescents. Nutrients. 2019 Aug 2;11(8):1788. doi: 10.3390/nu11081788. PMID: 31382417; PMCID: PMC6723651.
6. Marchesini G, Bugianesi E, Forlani G, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 2003; 37:917–923
7.Bussler S, Penke M, Flemming G, Elhassan YS, Kratzsch J, Sergeyev E, Lipek T, Vogel M, Spielau U, Körner A, de Giorgis T, Kiess W. Novel Insights in the Metabolic Syndrome in Childhood and Adolescence. Horm Res Paediatr. 2017;88(3-4):181-193. doi: 10.1159/000479510. Epub 2017 Aug 28. PMID: 28848168.

8.Neitzke U, Harder T, Plagemann A: Intrauterine growth restriction and developmental programming of the metabolic syndrome: a critical appraisal. Microcirculation 2011;18: 304–311.
9. Smith CJ, Ryckman KK: Epigenetic and developmental influences on the risk of obesity, diabetes, and metabolic syndrome. Diabetes Metab Syndr Obes 2015;8:295–302.
10. Boney CM, Verma A, Tucker R, Vohr BR: Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 2005; 115:e290–e296.
11.Marzuillo P, Miraglia del Giudice E, Santoro N: Pediatric fatty liver disease: role of ethnicity and genetics. World J Gastroenterol 2014; 20:7347–7355.
12. Welsh JA, Karpen S, Vos MB: Increasing prevalence of nonalcoholic fatty liver disease among United States adolescents, 1988–1994 to 2007–2010. J Pediatr 2013;162:496.
13. Clemente MG, Mandato C, Poeta M, Vajro P: Pediatric non-alcoholic fatty liver disease: recent solutions, unresolved issues, and future research directions. World J Gastroenterol 2016;22:8078–8093.
14. Giorgio V, Prono F, Graziano F, Nobili V: Pediatric non alcoholic fatty liver disease: old and new concepts on development, progression, metabolic insight and potential treatment targets. BMC Pediatr 2013;13:40.
15. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH: Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med 2003;157:821–827.
16. Bonci E, Chiesa C, Versacci P, Anania C, Silvestri L, Pacifico L: Association of nonalcoholic fatty liver disease with subclinical cardiovascular changes: a systematic review and meta-analysis. Biomed Res Int 2015;2015: 213737.
17. Lonardo A, Ballestri S, Marchesini G, Angulo P, Loria P: Nonalcoholic fatty liver disease: a precursor of the metabolic syndrome. Dig Liver Dis 2015;47:181–190.
18 Sundaram SS, Zeitler P, Nadeau K: The metabolic syndrome and non-alcoholic fatty liver disease in children. Curr Opin Pediatr 2009; 21:529–535.
19. Penke M, Kiess W, Giorgis T: Non-alcoholic fatty liver disease in children and adolescents. J Pediatr Endocrinol Metab 2016;29:1329– 1330.
20.Zhang Y, Li C, Li H, Song Y, Zhao Y, Zhai L, Wang H, Zhong R, Tang H, Zhu D: miR-378 Activates the pyruvate-PEP futile cycle and enhances lipolysis to ameliorate obesity in mice. EBioMedicine 2016;5:93–104
21.Kotnik P, Fischer PP, Wabitsch M: Endocrine and metabolic effects of adipose tissue in children and adolescents. Zdr Varst 2015;54:131– 138.
22. Alterio A, Alisi A, Liccardo D, Nobili V: Nonalcoholic fatty liver and metabolic syndrome in children: a vicious circle. Horm Res Paediatr 2014;82:283–289

Most read articles by the same author(s)