Home Medicine Dietary fructose intake in obese children and adolescents: relation to procollagen type III N-terminal peptide (P3NP) and non-alcoholic fatty liver disease
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Dietary fructose intake in obese children and adolescents: relation to procollagen type III N-terminal peptide (P3NP) and non-alcoholic fatty liver disease

  • Rasha Tarif Hamza EMAIL logo , Alaa Youssef Ahmed , Doaa Gamal Rezk and Amira Ibrahim Hamed
Published/Copyright: July 21, 2016
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 29 Issue 12

Abstract

Background:

Excessive use of fructose has been incriminated as a risk factor for hepatic steatosis. Procollagen type III N-terminal peptide (P3NP) is a marker for steatohepatitis. Thus, we aimed to assess fructose intake in obese children and its relation to nonalcoholic fatty liver disease (NAFLD) and P3NP.

Methods:

Fifty-five obese children were compared to 30 controls. All were subjected to dietary fructose and anthropometric assessment, fasting blood sugar (FBS), fasting insulin (FI) and homeostasis model assessment of insulin resistance (HOMA-IR), lipid profile, uric acid, alanine aminotransferase (ALT), P3NP and abdominal ultrasound.

Results:

Patients had higher fructose intake which was associated with increased NAFLD grade. There was an increase in P3NP with increased NAFLD grade. P3NP correlated positively with fructose intake (processed sources and total) and caloric intake.

Conclusions:

High fructose intake is associated with NAFLD and P3NP may serve as a marker of NAFLD in obese children with a proposed cutoff value of 8.5 ng/mL.

Keywords: dietary; fructose; nonalcoholic fatty liver disease; obesity; procollagen type III N-terminal peptide
Corresponding author: Rasha Tarif Hamza, MD, Professor of Pediatrics and Pediatric Endocrinology, Faculty of Medicine, Ain Shams University, 36 Hisham Labib Street, Off Makram Ebeid Street, Nasr City, Cairo 11371, Egypt, Phone: +202 22734727, Fax: +202 26904430

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Marzuillo P, Grandone A, Perrone L, Miraglia Del Giudice E. Controversy in the diagnosis of pediatric non-alcoholic fatty liver disease. World J Gastroenterol 2015;21:6444–50.10.3748/wjg.v21.i21.6444Search in Google Scholar PubMed PubMed Central

2. Papandreou D, Andreou E. Role of diet on non-alcoholic fatty liver disease: an updated narrative review. World J Hepatol 2015;7:575–82.10.4254/wjh.v7.i3.575Search in Google Scholar PubMed PubMed Central

3. Tanwar S, Trembling PM, Guha IN, Parkes J, Kaye P, et al. Validation of terminal peptide of procollagen III for the detection and assessment of nonalcoholic steatohepatitisin patients with nonalcoholic fatty liver disease. Hepatology 2013;57: 103–11.10.1002/hep.26030Search in Google Scholar PubMed

4. Niemelä O, Risteli L, Parkkinen J, Risteli J. Purification and characterization of the N-terminal propeptide of human type III procollagen. Biochem 1985;232:145–50.10.1042/bj2320145Search in Google Scholar PubMed PubMed Central

5. Bolarin DM, Azinge EC. Biochemical markers, extracellular components in liver fibrosis and cirrhosis. Nig Q J Hosp Med 2007;17:42–52.10.4314/nqjhm.v17i1.12541Search in Google Scholar PubMed

6. Cole TJ. A chart to link child centiles of body mass index, weight and height. Eur J Clin Nutr 2002;56:1196–9.10.1038/sj.ejcn.1601473Search in Google Scholar PubMed

7. Tanner JM, Whitehouse RH, Takaishi M. Standards from birth to maturity for height, weight, height velocity and weight velocity; British children, 1965. Arch Dis Child 1966;41:454–71, 613–35.10.1136/adc.41.219.454Search in Google Scholar PubMed PubMed Central

8. Schwandt P, Kelishadi R, Haas G. First reference curves of waist circumference for German children in comparison to international values: the PEP Family Heart Study. World J Pediatr 2008;4:259–66.10.1007/s12519-008-0048-0Search in Google Scholar PubMed

9. Mederico M, Paoli M, Zerpa Y, Briceño Y, Gómez-Pérez R, et al. Reference values of waist circumference and waist/hip ratio in children and adolescents of Mérida, Venezuela: comparison with international references. Endocrinol Nutr 2013;60:235–42.10.1016/j.endonu.2012.12.003Search in Google Scholar PubMed

10. Moreno LA, Fleta J, Mur L, Rodríquez G, Sarría A, et al. Waist circumference values in Spanish children-gender related differences. Eur J Clin Nutr 1999;53:429–33.10.1038/sj.ejcn.1600769Search in Google Scholar PubMed

11. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969;44:291–303.10.1136/adc.44.235.291Search in Google Scholar PubMed PubMed Central

12. Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child 1970;45:13–23.10.1136/adc.45.239.13Search in Google Scholar PubMed PubMed Central

13. National High Blood Pressure Education Program. Working Group on Hypertension Control in Children and Adolescents. Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program. Pediatrics 1996;98:649–58.10.1542/peds.98.4.649Search in Google Scholar

14. Dwyer JL. Dietary assessment in modern nutrition in health and disease, 12th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2003.Search in Google Scholar

15. Food Frequency Questionnaire: University of Cambridge. EPIC-Norfolk: nutritional methods. Available at: http://www.srl.cam.ac.uk/epic/nutmethod/FFQ.shtml. Accessed on 2/4/2013.Search in Google Scholar

16. Mahmoud KA, Armanious NN, Youssef SS, Abdullah RM, Said FS, et al. Dietary fructose. In: Hassan HA, Mosea W, Khadr S, editors. Health food guide for the Egyptian family, 4th edn. Cairo: National Institute of Nutrition, 2005.Search in Google Scholar

17. National Nutrition Institute. Food composition tables for Egypt, 2nd ed. Cairo, ARE: National Nutrition Institute, 2006.Search in Google Scholar

18. Soldin SJ. Uric acid, serum. In: Soldin SJ, Brugnara C, Wong EC, editors. Pediatric reference intervals, 6th edn. Washington, DC: AACC Press, 2007:270.Search in Google Scholar

19. National Cholesterol Education Program (NCEP). Expert panel of blood cholesterol levels in children and adolescents. Highlights of the report of the expert panel on blood cholesterol levels in children and adolescents. Pediatrics 1992;89:495–501.10.1542/peds.89.3.495Search in Google Scholar

20. American Diabetes Association Standards of Care for Diabetes. Brief summary of screening and diagnosis of type 2 diabetes and its complications. Diabetes Care 2013;36:S1.Search in Google Scholar

21. Sacks DB. Carbohydrates. In: Burtis CA, Ashwood ER, editors. Tietz textbook of clinical chemistery, 2nd ed. Philadelphia: W.B. Saunders Co, 1994.Search in Google Scholar

22. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412–9.10.1007/BF00280883Search in Google Scholar PubMed

23. Valerio G, Licenziati MR, Iannuzzi A, Franzese A, Siani P, et al. Insulin resistance and impaired glucose tolerance in obese children and adolescents from Southern Italy. Nutr Metab Cardiovasc Dis 2006;16:279–84.10.1016/j.numecd.2005.12.007Search in Google Scholar PubMed

24. Tester J, Sharma S, Jasik CB, Mietus-Snyder M, Tinajero-Deck L. Gender differences in prediabetes and insulin resistance among 1356 obese children in Northern California. Diabetes Metab Syndr 2013;7:161–5.10.1016/j.dsx.2013.06.002Search in Google Scholar PubMed

25. Saadeh S, Younossi ZM, Remer EM, Gramlich T, Ong JP, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 2002;123:3.10.1053/gast.2002.35354Search in Google Scholar PubMed

26. Singh AK, Amlal H, Haas PJ, Dringenberg U, Fussell S, et al. Fructose-induced hypertension: essential role of chloride and fructose absorbing transporters PAT1 and Glut5. Kidney Int 2008;74:438–47.10.1038/ki.2008.184Search in Google Scholar PubMed

27. Jia G, Aroor AR, Whaley-Connell AT, Sowers JR. Fructose and uric acid: is there a role in endothelial function? Curr Hypertens Rep 2014;16:434.10.1007/s11906-014-0434-zSearch in Google Scholar PubMed PubMed Central

28. Miller A, Adeli K. Dietary fructose and the metabolic syndrome. Curr Opin Gastroenterol 2008;24:204–9.10.1097/MOG.0b013e3282f3f4c4Search in Google Scholar PubMed

29. Schaefer EJ, Gleason JA, Dansinger ML. Dietary fructose and glucose differentially affect lipid and glucose homeostasis. J Nutr 2009;139:1257S–62S.10.3945/jn.108.098186Search in Google Scholar PubMed PubMed Central

30. Friedland O, Nemet D, Gorodnitsky G, Wolach B, Eliakim A. Obesity and lipid profiles in children and adolescents. J Pediat Endocr Met 2002;15:1011–6.10.1515/JPEM.2002.15.7.1011Search in Google Scholar PubMed

31. Kelishadi R, Mirmoghtadaee P, Najafi H, Keikha M. Systematic review on the association of abdominal obesity in children and adolescents with cardio-metabolic risk factors. J Res Med Sci 2015;20:294–307.Search in Google Scholar

32. Aeberli I, Zimmermann MB, Molinari L, Lehmann R, l’Allemand D, et al. Fructose intake is a predictor of LDL particle size in overweight school children. Am J Clin Nutr 2007;86:1174–8.10.1093/ajcn/86.4.1174Search in Google Scholar PubMed

33. Chung M, Ma J, Patel K, Berger S, Lau J, et al. Fructose, high-fructose corn syrup, sucrose, and nonalcoholic fatty liver disease or indexes of liver health: asystematic review and meta-analysis. Am J Clin Nutr 2014;100:833–49.10.3945/ajcn.114.086314Search in Google Scholar PubMed PubMed Central

34. Choi HK, Curhan G. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. Br Med J 2008;336:309–12.10.1136/bmj.39449.819271.BESearch in Google Scholar PubMed PubMed Central

35. Nguyen S, Choi HK, Lustig RH, Hsu CY. Sugar-sweetened beverages, serum uric acid, and blood pressure in adolescents. J Pediatr 2009;154:807–13.10.1016/j.jpeds.2009.01.015Search in Google Scholar PubMed PubMed Central

36. Welsh JA, Sharma A, Cunningham SA, Vos MB. Consumption of added sugars and indicators of cardiovascular disease risk among US adolescents. Circulation 2011;123:249–57.10.1161/CIRCULATIONAHA.110.972166Search in Google Scholar PubMed PubMed Central

37. Arslan N, Tokgoz Y, Kume T, Bulbul M, Sayın O, et al. Evaluation of serum neopterin levels and its relationship with adipokines in pediatric obesity-related nonalcoholic fatty liver disease and healthy adolescents. J Pediatr Endocr Met 2013;26:1141–7.10.1515/jpem-2013-0029Search in Google Scholar PubMed

38. Sullivan JS, Le MT, Pan Z, Rivard C, Love-Osborne K, et al. Oral fructose absorption in obese children with non-alcoholic fatty liver disease. Pediatr Obes 2015;10:188–95.10.1111/ijpo.238Search in Google Scholar PubMed PubMed Central

39. Tappy L, Lê KA. Metabolic effects of fructose and the worldwide increase in obesity. Physiol Rev 2010;90:23–46.10.1152/physrev.00019.2009Search in Google Scholar PubMed

Received: 2016-1-9
Accepted: 2016-5-26
Published Online: 2016-7-21
Published in Print: 2016-12-1

©2016 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Non-alcoholic fatty liver disease in children and adolescents
  4. Original Articles
  5. Serum vascular endothelial cadherin and thrombomodulin are markers of non-alcoholic fatty liver disease in children
  6. Ferritin level is associated with metabolic syndrome and elevated alanine aminotransferase in children and adolescents
  7. Dietary fructose intake in obese children and adolescents: relation to procollagen type III N-terminal peptide (P3NP) and non-alcoholic fatty liver disease
  8. Central diabetes insipidus: clinical profile that suggests organicity in Peruvian children: Lima – Peru 2001–2013
  9. Salivary flow rate, buffer capacity, and urea concentration in adolescents with type 1 diabetes mellitus
  10. Cortisol response to adrenocorticotropin testing in non-classical congenital adrenal hyperplasia (NCCAH)
  11. Efficacy of micellized vs. fat-soluble vitamin D3 supplementation in healthy school children from Northern India
  12. Growth curves for congenital adrenal hyperplasia from a national retrospective cohort
  13. The effects of type 1 diabetes mellitus on cardiac functions in children: evaluation by conventional and tissue Doppler echocardiography
  14. The association between single nucleotide polymorphisms of the Apelin gene and diabetes mellitus in a Chinese population
  15. Case Reports
  16. Successful transition to sulfonylurea therapy in two Iraqi siblings with neonatal diabetes mellitus and iDEND syndrome due to ABCC8 mutation
  17. A case of 46,XX dysgenesis and marked tall stature; the need for caution in interpreting array comparative genomic hybridization (CGH)
  18. Successful treatment of a child with a prolactin secreting macroadenoma with temozolomide
  19. Acknowledgment
  20. Acknowledgment
https://doi.org/10.1515/jpem-2016-0015
Keywords for this article
dietary; fructose; nonalcoholic fatty liver disease; obesity; procollagen type III N-terminal peptide

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Non-alcoholic fatty liver disease in children and adolescents
  4. Original Articles
  5. Serum vascular endothelial cadherin and thrombomodulin are markers of non-alcoholic fatty liver disease in children
  6. Ferritin level is associated with metabolic syndrome and elevated alanine aminotransferase in children and adolescents
  7. Dietary fructose intake in obese children and adolescents: relation to procollagen type III N-terminal peptide (P3NP) and non-alcoholic fatty liver disease
  8. Central diabetes insipidus: clinical profile that suggests organicity in Peruvian children: Lima – Peru 2001–2013
  9. Salivary flow rate, buffer capacity, and urea concentration in adolescents with type 1 diabetes mellitus
  10. Cortisol response to adrenocorticotropin testing in non-classical congenital adrenal hyperplasia (NCCAH)
  11. Efficacy of micellized vs. fat-soluble vitamin D3 supplementation in healthy school children from Northern India
  12. Growth curves for congenital adrenal hyperplasia from a national retrospective cohort
  13. The effects of type 1 diabetes mellitus on cardiac functions in children: evaluation by conventional and tissue Doppler echocardiography
  14. The association between single nucleotide polymorphisms of the Apelin gene and diabetes mellitus in a Chinese population
  15. Case Reports
  16. Successful transition to sulfonylurea therapy in two Iraqi siblings with neonatal diabetes mellitus and iDEND syndrome due to ABCC8 mutation
  17. A case of 46,XX dysgenesis and marked tall stature; the need for caution in interpreting array comparative genomic hybridization (CGH)
  18. Successful treatment of a child with a prolactin secreting macroadenoma with temozolomide
  19. Acknowledgment
  20. Acknowledgment
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