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Objective: Non-alcoholic fatty liver disease (NAFLD) is defined as chronic hepatic steatosis and is becoming prevalent, along with the increasing trend for obesity in children and adolescents. A non-invasive and reliable tool is needed to differentiate non-alcoholic steatohepatitis from simple steatosis. This study evaluated the association between the triglyceride glucose (TyG) index and the ultrasonographic fatty liver indicator (US-FLI), and the possibility of using the TyG index for prediction of severity of pediatric NAFLD., Methods: One hundred and twenty one patients who were diagnosed with NAFLD by ultrasonography were included. They were categorized into three groups according to body mass index (BMI). Ninety-two were obese, and 19 and 10 were overweight and normal weight, respectively., Results: The homeostatic model assessment for insulin resistance (HOMA-IR) was highest in the group with obesity (p=0.044). The TyG index and US-FLI did not differ significantly among the three BMI groups (p=0.186). Fourteen (11.6%) of the 121 patients had US-FLI ≥6, in whom the BMI-SDS and TyG index were higher (p=0.017, p=0.004), whereas HOMA-IR did not differ significantly from the group with US-FLI <6 (p=0.366). US-FLI was associated with BMI-SDS and the TyG index. TyG index was significantly associated with US-FLI after adjustment for BMI-SDS. The cut-off value for the TyG index for predicting US-FLI ≥6 was 8.91, with an area under the curve of 0.785., Conclusion: TyG index was associated with the degree of hepatic steatosis, suggesting that it might be a useful tool for predicting the severity of pediatric NAFLD., Competing Interests: Conflict of interest: None declared., (©Copyright 2024 by Turkish Society for Pediatric Endocrinology and Diabetes / The Journal of Clinical Research in Pediatric Endocrinology published by Galenos Publishing House.)

The triglyceride-glucose (TyG) index is associated with predicting type 2 diabetes mellitus (T2DM), but its relationship with homeostatic model assessment of insulin resistance (HOMA-IR) in T2DM is not established. We aimed to investigate the role of TyG index for detection of T2DM in children and adolescents and compare it with HOMA-IR. A cross sectional study was performed in 176 overweight or obese children and adolescents with mean age of 11.34 ± 3.24 years. TyG index was calculated as ln (fasting triglyceride (TG) [mg/dL] × fasting glucose [mg/dL]/2). Of a total of 176 subjects, 57 (32%) were diagnosed with T2DM. Significant differences were observed in the TyG index between T2DM and non-T2DM (p < 0.001). The TyG index had a positive correlation with fasting glucose (r = 0.519, p < 0.001), HOMA-IR (r = 0.189, p < 0.017), HbA1c (r = 0.429, p < 0.001), total cholesterol (TC) (r = 0.257, p = 0.001), TG (r = 0.759, p < 0.001), and low-density lipoprotein cholesterol (LDL-C)(r = 0.152, p < 0.001), and a negative correlation with high-density lipoprotein cholesterol (HDL-C)(r = -0.107, p < 0.001) after controlling for sex, age and BMI standard deviation scores (SDS). In multiple regression analyses, 91.8% of the variance in TyG index was explained by age, glucose, HOMA-IR, TG, LDL-C, and HDL-C (p < 0.001). In the receiver operating characteristic (ROC) analysis, the TyG index [area under the curve (AUC) 0.839)] showed a better performance compared to HOMA-IR (AUC 0.645) in identifying patients with T2DM (p < 0.001). In conclusion, the TyG index had significant association with insulin resistance in T2DM and was superior to HOMA-IR in predicting T2DM in children and adolescents.

The aim of the present study was to evaluate the association of irisin with obesity and metabolic syndrome (MetS) in Korean prepubertal children. A total of 96 children and adolescents aged 6 to 10 years (56 males) were included in this study. Subjects were divided into 3 groups: normal weight (n = 54), overweight (n = 16), and obese (n = 26). In the subgroup analyses, overweight/obese children were further divided based on their MetS status (with MetS vs. without MetS). Children with obesity tended to exhibit a lower mean irisin concentration compared to those with normal weight (p = 0.028). Using Pearson's correlation coefficient to compare all the children in the study, there was a significant inverse correlation between irisin and body mass index (BMI) standard deviation scores (SDS) (r = -0.210, p = 0.041), waist circumference SDS (r = -0.203, p = 0.049), and glucose (r = -0.296, p = 0.004). In the subgroup analyses of overweight/obese children, irisin exhibited a significant inverse correlation with glucose (r = -0.507, p = 0.001) and triglycerides (r = -0.331, p = 0.033). Children with MetS exhibited lower irisin concentrations than those without MetS (14.70 ng/mL vs. 22.02 ng/mL, p = 0.001), and these associations were significant after adjusting for age, gender, and BMI SDS (14.51 ng/mL vs. 22.06 ng/mL, p = 0.002). The irisin level of 15.43 ng/mL was determined to be a possible cutoff to distinguish children with metabolic syndrome from overweight/obese children, with a sensitivity of 75% and a specificity of 94% (p < 0.001). Our results suggest that decreased irisin levels may be associated with MetS in prepubertal children and that irisin might be a biomarker for MetS in prepubertal children.

Aim: Fetuin-A plays a role in insulin resistance and cardiovascular disease. This study aims to determine the relationship between fetuin-A levels and cardiometabolic risk factors, as well as to investigate the effect of serum fetuin-A on insulin resistance indices to determine whether fetuin-A is an additional marker for insulin resistance in prepubertal children., Methods: A total of 99 prepubertal Korean children (59 males) aged from 6.0 to 10.0 years was included in this study. Subjects were divided into underweight/normal-weight and overweight/obese groups. Serum fetuin-A levels were measured using an enzyme-linked immunosorbent assay and were natural logarithm (ln)-transformed., Results: Serum fetuin-A concentrations were significantly elevated in overweight/obese children as compared with underweight/normal-weight children (P=0.029). Ln serum fetuin-A was significantly positively correlated with body mass index (BMI) standard deviation scores (SDSs) (r=0.239, P=0.017), triglyceride levels (r=0.285, P=0.004), ln insulin (r=0.377, P＜0.001), systolic blood pressure (BP) (r=0.274, P=0.006), and diastolic BP (r=0.304, P=0.006) and was significantly inversely correlated with high-density lipoprotein cholesterol (HDL-C) levels (r=-0.236, P=0.019). In univariate linear regression analysis, ln fetuin-A was significantly positively associated with the homeostasis model assessment of insulin resistance (HOMA-IR) (r=0.356, P＜0.001) and significantly inversely associated with the quantitative insulin sensitivity check index (QUICKI) (r=-0.309, P=0.002). Following adjustment for age, gender, BMI, and lipid profiles in multivariate linear regression analysis, fetuin-A was significantly positively associated with HOMA-IR (P=0.048) and marginally inversely associated with QUICKI (P=0.054)., Conclusions: Our results suggest that fetuin-A can be an alternative marker for insulin resistance and cardiovascular risk in prepubertal children.

This study aimed to evaluate the associations of serum ferritin with insulin resistance indices, body fat mass/percentage, and all the components of metabolic syndrome (MetS), as well as the risk for MetS according to serum ferritin levels in Korean adolescents and adults.A total of 15,963 Korean males and females aged 16 to 80 years were analyzed using data from the Korean National Health and Nutrition Examination Survey, 2005 to 2011.The median serum ferritin concentration was 98.82 ng/mL for males and 38.60 ng/mL for females (P < 0.001). Increased risks of greater waist circumference and elevated glucose levels, elevated triglyceride levels, and reduced high-density lipoprotein cholesterol levels were noted across the serum ferritin quartiles after adjustment for confounders in both genders (P ≤ 0.012 for trend). Insulin resistance indices and abdominal obesity (trunk fat mass/percent) increased across the ferritin concentration quartiles after adjustment for confounders in males and females (P ≤ 0.011 for trend), and the risk of MetS increased across the ferritin quartiles in males (P < 0.001 for trend) and females (P = 0.001 for trend). The highest serum ferritin quartile exhibited a 1.62-fold increased risk of MetS (95% CI, 1.28-2.12) in males and a 1.36-fold increased risk of MetS (95% CI, 1.09-1.69) in females compared with the lowest quartile after adjustment for confounders.Our results suggest that ferritin is associated with insulin resistance and abdominal obesity.