Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Low Serum Potassium Levels Associated with Disease Severity in Children with Nonalcoholic Fatty Liver Disease

  • Received : 2015.04.13
  • Accepted : 2015.08.24
  • Published : 2015.09.30
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Abstract

Purpose: Recent studies have suggested that decreased serum potassium level may contribute to various metabolic disorders in adult patients including nonalcoholic fatty liver disease (NAFLD). We aimed to study the correlation between serum potassium levels and the histologic severity of NAFLD in children. Methods: Pediatric patients with biopsy-proven NAFLD were included in this study. Demographic, clinical, and histopathological data were obtained. Multivariable logistic regression analysis was used to assess whether potassium levels are associated with the presence of nonalcoholic steatohepatitis (NASH) or fibrosis after adjusting for possible confounders. A p-value <0.05 was considered statistically significant. Results: Among 125 biopsies, 49.6% (62) had evidence of NASH while 66.4% (83) had some degree of fibrosis (stage 1-3). Mean serum potassium was significantly lower in NASH group as compared to non-NASH group ($4.4{\pm}0.42mmoL/L$ vs. $4.8{\pm}0.21$, p<0.001). Higher potassium level had negative correlation with presence of steatosis, ballooning, lobular inflammation, fibrosis and NAFLD activity score (p<0.05). On multivariable analysis and after adjusting for the metabolic syndrome and insulin resistance, higher potassium level was significantly associated with lower likelihood of having a histological diagnosis of NASH on biopsy (odds ratio [OR], 0.12; 95% confidence interval [95% CI], 0.05-0.28; p<0.001). Similarly, the likelihood of having fibrosis decreases by 76% for every 0.5 mmoL/L increase in potassium (OR, 0.24; 95% CI, 0.11-0.54; p<0.001). Conclusion: Our study shows an inverse relationship between serum potassium levels and the presence of aggressive disease (NASH and fibrosis) in children with NAFLD.

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References

  1. Marchesini G, Brizi M, Bianchi G, Tomassetti S, Bugianesi E, Lenzi M, et al. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes 2001;50:1844-50. https://doi.org/10.2337/diabetes.50.8.1844
  2. Schwimmer JB, Deutsch R, Rauch JB, Behling C, Newbury R, Lavine JE. Obesity, insulin resistance, and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease. J Pediatr 2003;143:500-5. https://doi.org/10.1067/S0022-3476(03)00325-1
  3. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA 2012;307: 483-90. https://doi.org/10.1001/jama.2012.40
  4. Pacifico L, Nobili V, Anania C, Verdecchia P, Chiesa C. Pediatric nonalcoholic fatty liver disease, metabolic syndrome and cardiovascular risk. World J Gastroenterol 2011;17:3082-91.
  5. Tilg H, Moschen AR. Evolution of inflammation in nonalcoholic fatty liver disease: the multiple parallel hits hypothesis. Hepatology 2010;52:1836-46. https://doi.org/10.1002/hep.24001
  6. Asrih M, Jornayvaz FR. Inflammation as a potential link between nonalcoholic fatty liver disease and insulin resistance. J Endocrinol 2013;218:R25-36. https://doi.org/10.1530/JOE-13-0201
  7. Norbiato G, Bevilacqua M, Meroni R, Raggi U, Dagani R, Scorza D, et al. Effects of potassium supplementation on insulin binding and insulin action in human obesity: protein-modified fast and refeeding. Eur J Clin Invest 1984;14:414-9. https://doi.org/10.1111/j.1365-2362.1984.tb01205.x
  8. Mariosa LS, Ribeiro-Filho FF, Batista MC, Hirota AH, Borges RL, Ribeiro AB, et al. Abdominal obesity is associated with potassium depletion and changes in glucose homeostasis during diuretic therapy. J Clin Hypertens (Greenwich) 2008;10:443-9. https://doi.org/10.1111/j.1751-7176.2008.07817.x
  9. Rowe JW, Tobin JD, Rosa RM, Andres R. Effect of experimental potassium deficiency on glucose and insulin metabolism. Metabolism 1980;29:498-502. https://doi.org/10.1016/0026-0495(80)90074-8
  10. Sun K, Lu J, Jiang Y, Xu M, Xu Y, Zhang J, et al. Low serum potassium level is associated with nonalcoholic fatty liver disease and its related metabolic disorders. Clin Endocrinol (Oxf) 2014;80:348-55. https://doi.org/10.1111/cen.12168
  11. Alkhouri N, Dixon LJ, Feldstein AE. Lipotoxicity in nonalcoholic fatty liver disease: not all lipids are created equal. Expert Rev Gastroenterol Hepatol 2009; 3:445-51. https://doi.org/10.1586/egh.09.32
  12. Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F. Beneficial effects of a dietary approaches to stop hypertension eating plan on features of the metabolic syndrome. Diabetes Care 2005;28:2823-31. https://doi.org/10.2337/diacare.28.12.2823
  13. Nobili V, Marcellini M, Devito R, Ciampalini P, Piemonte F, Comparcola D, et al. NAFLD in children: a prospective clinical-pathological study and effect of lifestyle advice. Hepatology 2006;44:458-65. https://doi.org/10.1002/hep.21262
  14. Manco M, Bedogni G, Marcellini M, Devito R, Ciampalini P, Sartorelli MR, et al. Waist circumference correlates with liver fibrosis in children with non-alcoholic steatohepatitis. Gut 2008;57:1283-7. https://doi.org/10.1136/gut.2007.142919
  15. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000;320: 1240-3. https://doi.org/10.1136/bmj.320.7244.1240
  16. 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:e290-6. https://doi.org/10.1542/peds.2004-1808
  17. Fernández JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference percentiles in nationally representative samples of African-American, European- American, and Mexican-American children and adolescents. J Pediatr 2004;145:439-44. https://doi.org/10.1016/j.jpeds.2004.06.044
  18. Zahka KG. Report of the second task force on blood pressure control in children. Md Med J 1987;36:323-5.
  19. Genuth S, Alberti KG, Bennett P, Buse J, Defronzo R, Kahn R, et al; Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003;26:3160-7. https://doi.org/10.2337/diacare.26.11.3160
  20. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-9. https://doi.org/10.1007/BF00280883
  21. Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 1999;22:1462-70. https://doi.org/10.2337/diacare.22.9.1462
  22. Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 2000; 85:2402-10. https://doi.org/10.1210/jcem.85.7.6661
  23. Poynard T, Halfon P, Castera L, Charlotte F, Le Bail B, Munteanu M, et al; FibroPaca Group. Variability of the area under the receiver operating characteristic curves in the diagnostic evaluation of liver fibrosis markers: impact of biopsy length and fragmentation. Aliment Pharmacol Ther 2007;25:733-9. https://doi.org/10.1111/j.1365-2036.2007.03252.x
  24. Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, et al; Nonalcoholic Steatohepatitis Clinical Research Network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41:1313-21. https://doi.org/10.1002/hep.20701
  25. Sun K, Su T, Li M, Xu B, Xu M, Lu J, et al. Serum potassium level is associated with metabolic syndrome: a population-based study. Clin Nutr 2014;33:521-7. https://doi.org/10.1016/j.clnu.2013.07.010
  26. Ribeiro MC, Avila DS, Barbosa NB, Meinerz DF, Waczuk EP, Hassan W, et al. Hydrochlorothiazide and high-fat diets reduce plasma magnesium levels and increase hepatic oxidative stress in rats. Magnes Res 2013;26:32-40.

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