scholarly journals Development and Internal Validation of Fatty Liver Prediction Models in Obese Children and Adolescents

2021 ◽  
Vol 10 (7) ◽  
pp. 1470
Author(s):  
Giorgio Bedogni ◽  
Sofia Tamini ◽  
Diana Caroli ◽  
Sabrina Cicolini ◽  
Marco Domenicali ◽  
...  
Keyword(s):  
Uric Acid ◽  
Fatty Liver ◽  
Prediction Models ◽  
External Validation ◽  
Hdl Cholesterol ◽  
Outcome Variable ◽  
Model Assessment ◽  
Obese Children ◽  
Cross Sectional ◽  
Internal Validation

To develop predictive models of fatty liver (FL), we performed a cross-sectional retrospective study of 1672 obese children with a median (interquartile range) age of 15 (13–16) years. The outcome variable was FL diagnosed by ultrasonography. The potential predictors were: (1) binary: sex; (2) continuous: age, body mass index (BMI), waist circumference (WC), alanine transaminase (ALT), aspartate transaminase, gamma-glutamyltransferase, glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), HDL-cholesterol, LDL-cholesterol, triglycerides, mean arterial pressure, uric acid, and c-reactive protein; (3) ordinal: Pubertal status. Bootstrapped multivariable logistic regression with fractional polynomials was used to develop the models. Two models were developed and internally validated, one using BMI and the other using WC as the anthropometric predictor. Both models included ALT, HOMA-IR, triglycerides, and uric acid as predictors, had similar discrimination (c-statistic = 0.81), and were similarly well calibrated as determined by calibration plots. These models should undergo external validation before being employed in clinical or research practice.

Validation of FHWA Crash Models for Rural Intersections: Lessons Learned

2003 ◽  
Vol 1840 (1) ◽  
pp. 41-49 ◽  
Author(s):  
Jutaek Oh ◽  
Craig Lyon ◽  
Simon Washington ◽  
Bhagwant Persaud ◽  
Joe Bared
Keyword(s):  
Prediction Models ◽  
External Validation ◽  
National Level ◽  
Lessons Learned ◽  
Analysis Tool ◽  
Omitted Variables ◽  
Cross Sectional ◽  
Internal Validation ◽  
Before And After ◽  
Roadway Design

A national-level safety analysis tool is needed to complement existing analytical tools for assessment of the safety impacts of roadway design alternatives. FHWA has sponsored the development of the Interactive Highway Safety Design Model (IHSDM), which is roadway design and redesign software that estimates the safety effects of alternative designs. Considering the importance of IHSDM in shaping the future of safety-related transportation investment decisions, FHWA justifiably sponsored research with the sole intent of independently validating some of the statistical models and algorithms in IHSDM. Statistical model validation aims to accomplish many important tasks, including ( a) assessment of the logical defensibility of proposed models, ( b) assessment of the transferability of models over future time periods and across different geographic locations, and ( c) identification of areas in which future model improvements should be made. These three activities are reported for five proposed types of rural intersection crash prediction models. The internal validation of the model revealed that the crash models potentially suffer from omitted variables that affect safety, site selection and countermeasure selection bias, poorly measured and surrogate variables, and misspecification of model functional forms. The external validation indicated the inability of models to perform on par with model estimation performance. Recommendations for improving the state of the practice from this research include the systematic conduct of carefully designed before-and-after studies, improvements in data standardization and collection practices, and the development of analytical methods to combine the results of before-and-after studies with cross-sectional studies in a meaningful and useful way.

scholarly journals Ultrasound as a method to evaluate the distribution of abdominal fat in obese prepubertal children and the relationship between abdominal fat and metabolic alterations

2018 ◽  
Vol 51 (5) ◽  
pp. 293-296 ◽  
Author(s):  
Arine Santos Peçanha ◽  
Alexandra Maria Monteiro ◽  
Fernanda Mussi Gazolla ◽  
Isabel Rey Madeira ◽  
Maria Alice Neves Bordallo ◽  
...  
Keyword(s):  
Hdl Cholesterol ◽  
Serum Levels ◽  
Cross Sectional Study ◽  
Abdominal Fat ◽  
Normal Weight ◽  
Model Assessment ◽  
Obese Children ◽  
Cross Sectional ◽  
Prepubertal Children ◽  
Metabolic Alterations

Abstract Objective: To evaluate, using ultrasound, the distribution of abdominal fat in obese prepubertal children, as well as its possible correlation with metabolic changes due to obesity. Materials and Methods: This was a cross-sectional study of prepubescent children: 77 obese children (33 girls and 44 boys), with a mean age of 7.31 years; and 31 normal-weight children (17 girls and 14 boys), with a mean age of 7.32 years. In all of the children, abdominal wall thickness (AWT) and abdominal fat thickness (AFT) were measured by ultrasound. For the evaluation of the associated metabolic alterations, serum levels of glycemia, HDL cholesterol, triglycerides, and insulin were determined. Results: The obese children presented with greater abdominal fat, predominantly greater AWT, without a significant gender-related difference in AWT or AFT. The homeostasis model assessment of insulin resistance (HOMA-IR) showed a significant direct correlation with AWT and AFT. Conclusion: In obese prepubertal children, the AWT, as measured by ultrasound, was shown to be more closely related to the HOMA-IR than to the lipid metabolism or glycemia.

scholarly journals Association of Serum Bilirubin Level with Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study of 1672 Obese Children

2021 ◽  
Vol 10 (13) ◽  
pp. 2812
Author(s):  
Cristina Bellarosa ◽  
Giorgio Bedogni ◽  
Annalisa Bianco ◽  
Sabrina Cicolini ◽  
Diana Caroli ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Serum Bilirubin ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Obese Children ◽  
Cross Sectional ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

As in adults, obesity also plays a central role in the development of metabolic syndrome (MS) in children. Non-alcoholic fatty liver disease (NAFLD) is considered a manifestation of MS. Not only MS but also NAFLD seem to be inversely associated with serum bilirubin concentrations, an important endogenous tissue protector when only mild elevated. The aim of the study was to evaluate the association between serum bilirubin levels and the prevalence of MS and NAFLD in Italian obese children and adolescents. A retrospective cross-sectional study was performed in 1672 patients aged from 5 to 18 years. Clinical and laboratory parameters were assessed. NAFLD was measured by liver ultrasonography. The study was approved by the Ethical Committee of the Istituto Auxologico Italiano (research project code 1C021_2020, acronym BILOB). MS was present in 24% and fatty liver (FL) in 38% of this population. Bilirubin was not associated with FL and MS as a whole, but it was inversely associated only with selected components of MS, i.e., large WC, high blood pressure and high triglycerides. Our data suggest that bilirubin is not protective against MS and NAFLD in the presence of severe obesity.

scholarly journals Albuminuria and glomerular filtration rate in obese children and adolescents

2019 ◽  
Vol 41 (2) ◽  
pp. 193-199
Author(s):  
Luciana Satiko Sawamura ◽  
Gabrielle Gomes de Souza ◽  
Juliana Dias Gonçalves dos Santos ◽  
Fabíola Isabel Suano-Souza ◽  
Anelise Del Vecchio Gessullo ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Children And Adolescents ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Cross Sectional Study ◽  
Systemic Arterial Pressure ◽  
Model Assessment ◽  
Obese Children ◽  
Cross Sectional ◽  
The Mean

Abstract Objective: To describe the frequency of albuminuria in overweight and obese children and adolescents and to relate it to the severity of obesity, pubertal staging, associated morbidities and the glomerular filtration rate. Method: Cross-sectional study including 64 overweight and obese children and adolescents between 5 and 19 years of age. Data collected: weight, height, waist circumference and systemic arterial pressure. Laboratory tests: lipid profile; glycemia and insulin, used to calculate the Homeostasis Model Assessment (HOMA-IR); C-reactive protein; glutamic-pyruvic transaminase and albuminuria in an isolated urine sample (cutoff <30 mg/g). Creatinine was used to calculate the estimated glomerular filtration rate (eGFR, mL/min/1.73 m2). Results: The mean age was 11.6 ± 3.4 years, 32 (50%) and 29 (45.3%) were male and prepubertal. Forty-six (71.9%) had severe obesity. The frequency and median (min/max) of the observed values for albuminuria (> 30 mg/g) were 14 (21.9%) and 9.4 mg/g (0.70, -300.7 mg/g). The mean eGFR was 122.9 ± 24.7 mL/min/1.73 m2. There was no significant correlation between body mass index, pubertal staging, insulin and HOMA-IR with albuminuria values and neither with eGFR. Children with albuminuria tended to have higher values of diastolic blood pressure (75.0 ± 12.2 vs. 68.1 ± 12.4, p = 0.071). Conclusion: Albuminuria, although frequent in children and adolescents with obesity, was not associated with other morbidities and the glomerular filtration rate in these patients.

scholarly journals Dietary determinants of hepatic fat content and insulin resistance in overweight/obese children: a cross-sectional analysis of the Prevention of Diabetes in Kids (PREDIKID) study

2019 ◽  
Vol 121 (10) ◽  
pp. 1158-1165 ◽  
Author(s):  
Lide Arenaza ◽  
María Medrano ◽  
Maddi Oses ◽  
Inge Huybrechts ◽  
Ignacio Díez ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Dietary Intake ◽  
Dietary Habits ◽  
Sugar Content ◽  
Model Assessment ◽  
Obese Children ◽  
Cross Sectional ◽  
Alcoholic Fatty Liver ◽  
Sugar Intake ◽  
Hepatic Fat

AbstractPaediatric non-alcoholic fatty liver disease has increased in parallel with childhood obesity. Dietary habits, particularly products rich in sugars, may influence both hepatic fat and insulin resistance (homeostatic model assessment for insulin resistance (HOMA-IR)). The aim of the study was to examine the association of the consumption of foods and food components, dairy desserts and substitutes (DDS), sugar-sweetened beverages (SSB), as well as total and added sugars, with hepatic fat and HOMA-IR. Dietary intake (two non-consecutive 24 h-recalls), hepatic fat (MRI) and HOMA-IR were assessed in 110 overweight/obese children (10·6 (sd 1·1) years old). Linear regression analyses were used to examine the association of dietary intake with hepatic fat and HOMA-IR adjusted for potential confounders (sex, age, energy intake, maternal educational level, total and abdominal adiposity and sugar intake). The results showed that there was a negative association between cereal intake and hepatic fat (β=–0·197, P<0·05). In contrast, both SSB consumption (β=0·217; P=0·028) and sugar in SSB (β=0·210, P=0·035), but not DDS or sugar in DDS or other dietary components, were positively associated with hepatic fat regardless of potential confounders including total sugar intake. In conclusion, cereal intake might decrease hepatic fat, whereas SSB consumption and its sugar content may increase the likelihood of having hepatic steatosis. Although these observations need to be confirmed using experimental evidence, these results suggest that healthy lifestyle intervention programs are needed to improve dietary habits as well as to increase the awareness of the detrimental effects of SSB consumption early in life.

scholarly journals Serum uric acid and its association with metabolic syndrome and carotid atherosclerosis in obese children

2009 ◽  
Vol 160 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Lucia Pacifico ◽  
Vito Cantisani ◽  
Caterina Anania ◽  
Elisabetta Bonaiuto ◽  
Francesco Martino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Uric Acid ◽  
Carotid Atherosclerosis ◽  
Resistance Index ◽  
Model Assessment ◽  
Obese Children ◽  
Pubertal Stage ◽  
Carotid Imt

ObjectiveThe association between hyperuricemia, metabolic syndrome (MS), and atherosclerotic vascular disease has been reported in adults, but very little is known about this association in children. The aims of our study were to ascertain the correlates of uric acid (UA) in a sample of obese children, and to investigate whether UA is associated with carotid intima-media thickness (IMT) independently from classical risk factors including MS.MethodsWe analyzed carotid IMT along with serum triglycerides, total and high-density lipoprotein cholesterol, glucose, insulin, insulin resistance index (as homeostasis model assessment of insulin resistance), alanine aminotransferase, γ-glutamyltransferase, creatinine, and UA in 120 obese children and 50 healthy control children.ResultsUA concentrations were significantly higher in obese children compared with controls; moreover, they correlated with the most established cardiovascular risk factors. In the group of obese children, after adjustment for age, sex, pubertal stage, and creatinine, an independent association between UA levels and the presence of MS syndrome was observed (unstandardized coefficient, 0.044 (95% confidence intervals (CI) 0.015–0.072); P<0.01). Carotid IMT significantly increased in the fourth quartile of UA compared with that in the first, second, and third quartile (0.49 (0.46–0.53), 0.53 (0.49–0.56), and 0.55 (0.52–0.59) vs 0.61 (95% CI, 0.58–0.64); P<0.01). When multivariate analysis was performed after adjusting for age, gender, pubertal stage, creatinine, and MS (considered as a single clinical entity), or the individual components of MS simultaneously included, the association between UA and carotid IMT was significant (P<0.01).ConclusionsIn obese children and adolescents, increased UA levels are associated with carotid atherosclerosis.

scholarly journals Dyslipidemia and Fatty Liver Disease in Overweight and Obese Children

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Asma Deeb ◽  
Salima Attia ◽  
Samia Mahmoud ◽  
Ghada Elhaj ◽  
Abubaker Elfatih
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Cross Sectional Study ◽  
Obese Children ◽  
Gulf Region ◽  
Anthropometric Measures ◽  
Cross Sectional ◽  
Low Hdl ◽  
Liver Transaminases

Introduction. Obesity is a worldwide concern. It is associated with morbidity such as dyslipidemia and liver disease. Childhood obesity has dramatically increased, particularly in the Gulf region. We aim to assess the prevalence of dyslipidemia and fatty liver disease (FLD) in overweight and obese children and analyze the association between different anthropometric measures with dyslipidemia and fatty liver disease. Methods. A descriptive, cross-sectional study conducted on children referred with obesity. BMI percentiles were plotted and standardized waist circumference (WC) was generated. Family history of metabolic syndrome was recorded. Fasting lipid, liver transaminases, and ultrasound scans (US) for those with elevated enzymes were performed. Descriptive statistics were used for quantitative parameters. Results. 216 participants were recruited. Mean ± SD age was 10.58 ± 2.996 years. 55.3% had dyslipidemia; 11.7% had high cholesterol, 28.6% high triglyceride, 32.7% high LDL, and 18.0% low HDL. 51 (84%) had either elevated transaminases. All had liver US, and 43 had FLD. WC was strongly associated with dyslipidemia and FLD (P=0.04  and  0.003). Conclusion. Dyslipidemia is common in overweight, obese children. FLD is prevalent in those with elevated liver transaminases. WC is an easy tool that can be utilized to screen for dyslipidemia and FLD in overweight and obese children.

scholarly journals Prediction Models in Women with Postmenopausal Bleeding: A Systematic Review

2012 ◽  
Vol 8 (3) ◽  
pp. 251-262 ◽  
Author(s):  
Nehalennia van Hanegem ◽  
Maria C Breijer ◽  
Brent C Opmeer ◽  
Ben WJ Mol ◽  
Anne Timmermans
Keyword(s):  
Endometrial Cancer ◽  
Impact Analysis ◽  
Prediction Models ◽  
External Validation ◽  
Power Doppler ◽  
Elevated Risk ◽  
Postmenopausal Bleeding ◽  
Internal Validation ◽  
Phases Of Development ◽  
Analysis Models

Postmenopausal bleeding is associated with an elevated risk of having endometrial cancer. The aim of this review is to give an overview of existing prediction models on endometrial cancer in women with postmenopausal bleeding. In a systematic search of the literature, we identified nine prognostic studies, of which we assessed the quality, the different phases of development and their performance. From these data, we identified the most important predictor variables. None of the detected models completed external validation or impact analysis. Models including power Doppler showed best performance in internal validation, but Doppler in general gynecological practice is not easily accessible. We can conclude that we have indications that the first step in the approach of women with postmenopausal bleeding should be to distinguish between women with low risk versus high risk of having endometrial carcinoma and the next step would be to refer patients for further (invasive) testing.

Hyperuricemia and Metabolic Adverse Effect in Children and Adolescents with Autism Spectrum Disorder Treated with Risperidone

2017 ◽  
Vol 41 (S1) ◽  
pp. s305-s306
Author(s):  
C. Sukasem
Keyword(s):  
Uric Acid ◽  
Children And Adolescents ◽  
Laboratory Data ◽  
Autism Spectrum ◽  
High Dose ◽  
Model Assessment ◽  
Duration Of Treatment ◽  
Cross Sectional ◽  
Long Term Treatment ◽  
Adolescents With Asd

BackgroundAtypical anti-psychotics have been found to be associated with hyperuricemia. The aims of this study were to determine the prevalence of hyperuricemia and metabolic adverse events in children and adolescents with ASD treated with risperidone.MethodsIn this cross-sectional study, we recruited 127 Thai ASD children and adolescents aged 3–20 years receiving risperidone for more than 4 weeks. The clinical data and laboratory data were obtained and analyzed. Hyperuricemia was defined as serum uric acid > 5.5 mg/dL.ResultsHyperuricemia was present in 57.48% of total ASD patients treated with risperidone. Uric acid levels were significantly higher in adolescents as compared to children. Uric acid levels correlated with risperidone dose (P = 0.01), duration of treatment (P < 0.0001), BMI (P < 0.0001), waist circumference (P = 0.003), triglyceride (TG; P < 0.0001), triglycerides/high-density lipoprotein cholesterol ratio (TG/HDL-C; P < 0.0001), insulin (P = 0.04), homeostatic model assessment index (HOMA-IR; P = 0.03), high-sensitivity CRP (hs-CRP; P < 0.0001), and leptin levels (P < 0.0001). HDL-C and adiponectin levels were negatively correlated with uric acid levels (P < 0.0001). In multiple regressions analysis, age, BMI, TG/HDL-C, and adiponectin level remained significantly associated with uric acid levels (P < 0.0001).ConclusionHyperuricemia may play a role in metabolic adverse effects in children and adolescents with ASD receiving high dose and/or long-term treatment with risperidone.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

scholarly journals Oxidative stress and nitric oxide are increased in obese children and correlate with cardiometabolic risk and renal function

2016 ◽  
Vol 116 (5) ◽  
pp. 805-815 ◽  
Author(s):  
Liane Correia-Costa ◽  
Teresa Sousa ◽  
Manuela Morato ◽  
Dina Cosme ◽  
Joana Afonso ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Nitric Oxide ◽  
Renal Function ◽  
Cardiometabolic Risk ◽  
Linear Trend ◽  
Normal Weight ◽  
No Production ◽  
Model Assessment ◽  
Obese Children ◽  
Cross Sectional

AbstractOxidative stress and nitric oxide (NO) appear to represent important links between obesity and cardiovascular, metabolic and/or renal disease. We investigated whether oxidative stress and NO production/metabolism are increased in overweight and obese prepubertal children and correlate with cardiometabolic risk and renal function. We performed a cross-sectional evaluation of 313 children aged 8–9 years. Anthropometrics, 24-h ambulatory blood pressure, pulse wave velocity (PWV), insulin resistance (homoeostasis model assessment index (HOMA-IR)), inflammatory/metabolic biomarkers, estimated glomerular filtration rate (eGFR), plasma total antioxidant status (TAS), plasma and urinary isoprostanes (P-Isop, U-Isop), urinary hydrogen peroxide (U-H2O2), and plasma and urinary nitrates and nitrites (P-NOx, U-NOx) were compared among normal weight, overweight and obese groups, according to WHO BMI z-score reference. U-Isop were increased in the obese group, whereas U-NOx were increased in both overweight and obese children. U-Isop were positively correlated with U-H2O2, myeloperoxidase (MPO), high-sensitivity C-reactive protein, HOMA-IR and TAG. TAS correlated negatively with U-Isop and MPO and positively with PWV. HOMA-IR and U-H2O2 were associated with higher U-Isop, independently of BMI and eGFR, and total cholesterol and U-H2O2 were associated with U-NOx, independently of BMI, eGFR values and P-NOx concentration. In overweight and obese children, eGFR decreased across P-NOx tertiles (median: 139·3 (25th, 75th percentile 128·0, 146·5), 128·0 (25th, 75th percentile 121·5, 140·4), 129·5 (25th, 75th percentile 119·4, 138·3), Pfor linear trend=0·003). We conclude that oxidant status and NO are increased in relation to fat accumulation and, even in young children, they translate into higher values of cardiometabolic risk markers and affect renal function.

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