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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pediatr. | doi: 10.3389/fped.2019.00420

Including Fibroblast Growth Factor-21 in Combined Biomarker Panels Improves Predictions of Liver Steatosis Severity in Children

 Man-Chin Hua1, Jing-Long Huang2, Ching-Chih Hu1, Tsung-Chieh Yao3* and Ming-Wei Lai2*
  • 1Keelung Chang Gung Memorial Hospital, Taiwan
  • 2Linkou Chang Gung Memorial Hospital, Taiwan
  • 3Chang Gung University, Taiwan

Background: Previous studies reported conflicting results regarding the association between fibroblast growth factor-21 (FGF-21) and nonalcoholic fatty liver disease (NAFLD). This study aimed to evaluate the feasibility of combining FGF-21, obesity indices, and biochemical tests for predicting high-grade liver steatosis in children.
Methods: A total of 203 children and adolescents aged 5–18 years were enrolled, and their anthropometric data, body composition, liver ultrasound score for NAFLD (range, 0–6), biochemical test results, and FGF-21, leptin, and adiponectin levels were analyzed. Children were categorized according to body mass index (BMI) and NAFLD scores. Univariate analysis and multivariate linear regression were used to identify independent predictors for the degree of liver steatosis. The accuracy of the models was also evaluated using a receiver-operating characteristic (ROC) curve.
Results: FGF-21 levels were significantly higher in subjects with high-grade liver steatosis (P < 0.001). In obese and overweight children, regression analysis indicated that higher BMI and higher gamma-glutamyl transferase (γ-GT), triglycerides (TG), and FGF-21 levels were independent risk factors strongly correlated with NAFLD scores. FGF-21 combined with any of the above parameters showed a larger area under the ROC (AUROC, 0.861–0.873) than either parameter used alone. Overall, the best performance was obtained by combing FGF-21, γ-GT, and TG, with an AUROC of 0.871, specificity of 82.54%, and sensitivity of 83.78% for predicting high-grade liver steatosis.
Conclusion: BMI, FGF-21, γ-GT, and TG levels were strongly correlated with liver steatosis severity. Including FGF-21 in the biomarker panels may improve the accuracy for identifying obese and overweight children with high-grade liver steatosis.

Keywords: Childhood obesity and its complications, Combined analysis, Fibroblast growth factor 21 (FGF21), Liver steatosis, predictors

Received: 10 Jun 2019; Accepted: 02 Oct 2019.

Copyright: © 2019 Hua, Huang, Hu, Yao and Lai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Dr. Tsung-Chieh Yao, Chang Gung University, Taoyuan, 33333, Taichung County, Taiwan,
Dr. Ming-Wei Lai, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan,