Increased circulating zonulin in children with biopsy-proven nonalcoholic fatty liver disease

Table 1 Characteristics of obese children by liver status

	No NAFLD (n = 40)	NAFLD (n = 40)	P value
Age, yr1	11.10 (3.1)	11.10 (3.1)
Male gender1	25 (62.5)	25 (62.5)
BMI-SD score	2.10 (0.32)	2.15 (0.50)	0.5600
Waist circumference, cm	92 (12)	97 (12)a	0.0270
Abdominal fat
Visceral adipose tissue, cm2	284 (217-502)	447 (337-676)	0.0040
Subcutaneous adipose tissue, cm2	1648 (1301-2503)	1828 (1629-2471)	0.2200
Hepatic fat fraction	1.5% (1.0%-3.0%)	16.0% (10.0%-30.0%)	< 0.0001
Triglycerides, mg/dL	81 (52-114)	96 (68-149)	0.0490
Total cholesterol, mg/dL	154 (142-185)	149 (130-179)	0.1100
HDL-C, mg/dL	49 (43-54)	45 (37-53)	0.3100
Aspartate aminotransferase, U/L	25 (11)	34 (26)	0.0370
Alanine aminotransferase, U/L	26 (17)	50 (43)	< 0.0001
γ-glutamyl transferase, U/L	15 (8)	23 (12)	< 0.0001
Fasting glucose, mg/dL	85 (6)	83 (8)	0.3300
2-h glucose, mg/dL	94 (13)	93 (14)	0.8700
Fasting insulin, μU/mL	11 (8-15)	20 (15-28)	0.0010
2-h insulin, μU/mL	35 (23-63)	67 (29-107)	0.0070
Fasting C peptide, pmol/L	780 (576-887)	1075 (816-1302)	< 0.0001
HOMA-IR values	2.24 (1.80-3.17)	4.11 (2.95-6.67)	0.0030
WBISI	5.84 (3.16-6.87)	2.57 (1.58-5.36)	0.0020
HbA1c	5.0% (0.32)	5.4% (0.47)	0.0170
HSCRP, μg/L	1800 (1000-3200)	3000 (1500-4325)	0.0490
Zonulin, ng/mL	3.31 (2.05-4.63)	4.23 (3.18-5.89)	0.0090

¹Matched variables. Results are expressed as n (%), mean ± SD, or median (IQR). BMI-SDS: Body mass index-standard deviation score; HDL-C: High-density lipoprotein cholesterol; HOMA-IR: Homeostasis model assessment of insulin resistance; WBISI: Whole-body insulin sensitivity index; HbA_1c: Haemoglobin A_1c; HSCRP: High-sensitive C reactive protein; NAFLD: Nonalcoholic fatty liver disease.

Table 2 Dietary and physical activity pattern

	No NAFLD(n = 40)	NAFLD(n = 40)
Diet
Energy intake, kcal/d	1633 (1380-1840)	1641 (1341-1964)
Protein, % kcal	18 (15-20)	17 (16-19)
Fat, % kcal	38 (35-46)	39 (36-46)
Carbohydrates, % kcal	40 (36-46)	41 (35-46)
Fiber, g/kcal	11 (9-15)	10 (7-13)
Saturated fatty acids, g/d	20 (16-24)	24 (15-33)
Mono unsaturated fatty acids, g/d	42 (29-46)	34 (26-47)a
Polyunsaturated fatty acids, g/d	10 (9-12)	9 (7-10)a
Sugar-sweetened beverage, kcal/da	30 (13-46)	118 (10-162)a
Daily physical activity level-MET	3.0 (2.4-3.3)	3.5 (2.8-4.6)

Results are expressed as median (IQR). MET: Metabolic equivalent.

^aP < 0.05 vs no nonalcoholic fatty liver disease (NAFLD) group.

Table 3 Histopathological features of the 40 study children with nonalcoholic fatty liver disease according to the presence or absence of nonalcoholic steatohepatitis n (%)

Histopathological features	Degree or stage	No NASH(n = 15)	NASH(n = 25)
Steatosis	1	8 (53.3)	3 (12.0)
	2	5 (33.3)	8 (32.0)
	3	2 (13.3)	14 (56.0)
Lobular inflammation	0	1 (6.7)	0
	1	10 (66.6)	8 (32.0)
	2	4 (26.6)	12 (48.0)
	3	0	5 (20)
Ballooning	0	4 (26.6)	0
	1	10 (66.6)	18 (72.0)
	2	1 (6.7)	7 (28.0)
Fibrosis	0	3 (20.0)	7 (28.0)
	1	8 (53.3)	8 (32.0)
	2	4 (26.6)	9 (36.0)
	3	0	1 (4.0)
NAS, mean ± SD		2.60 ± 0.41	5.45 ± 0.63

NAS: Nonalcoholic fatty liver disease activity score; NASH: Nonalcoholic steatohepatitis.