Prevalence of Nonalcoholic Fatty Liver Disease in Children with Obesity - 17/12/18

Doi : 10.1016/j.jpeds.2018.11.021

Elizabeth L. Yu, MD ^1,², Shahrokh Golshan, PhD ³, Kathryn E. Harlow, MD ^1,², Jorge E. Angeles, MD ¹, Janis Durelle, BS ¹, Nidhi P. Goyal, MD ^1,², Kimberly P. Newton, MD ^1,², Mary Catherine Sawh, MD ^1,², Jonathan Hooker, BS ⁴, Ethan Z. Sy, BS ⁴, Michael S. Middleton, MD, PhD ⁴, Claude B. Sirlin, MD ⁴, Jeffrey B. Schwimmer, MD ^1,^2,^*
¹ Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, CA
² Department of Gastroenterology, Rady Children's Hospital, San Diego, CA
³ Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA
⁴ Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA

^*Reprint requests: Jeffrey B. Schwimmer, MD, Fatty Liver Clinic, Department of Pediatrics, UC San Diego, 3020 Children's Way, MC 5030, San Diego, CA 92123.Fatty Liver ClinicDepartment of PediatricsUC San Diego3020 Children's WayMC 5030San DiegoCA92123

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 17 December 2018

Abstract

Objectives

To determine the prevalence of nonalcoholic fatty liver disease (NAFLD) in children with obesity because current estimates range from 1.7% to 85%. A second objective was to evaluate the diagnostic accuracy of alanine aminotransferase (ALT) for NAFLD in children with obesity.

Study design

We evaluated children aged 9-17 years with obesity for the presence of NAFLD. Diseases other than NAFLD were excluded by history and laboratories. Hepatic steatosis was measured by liver magnetic resonance imaging proton density fat fraction. The diagnostic accuracy of ALT for detecting NAFLD was evaluated.

Results

The study included 408 children with obesity that had a mean age of 13.2 years and mean body mass index percentile of 98.0. The study population had a mean ALT of 32 U/L and median hepatic magnetic resonance imaging proton density fat fraction of 3.7%. The estimated prevalence of NAFLD was 26.0% (95% CI 24.2%-27.7%), 29.4% in male patients (CI 26.1%-32.7%) and 22.6% in female patients (CI 16.0%-29.1%). Optimal ALT cut-point was 42 U/L (47.8% sensitivity, 93.2% specificity) for male and 30 U/L (52.1% sensitivity, 88.8% specificity) for female patients. The classification and regression tree model with sex, ALT, and insulin had 80% diagnostic accuracy for NAFLD.

Conclusions

NAFLD is common in children with obesity, but NAFLD and obesity are not concomitant. In children with obesity, NAFLD is present in nearly one-third of boys and one-fourth of girls.

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Keywords : pediatric, NAFLD, BMI

Abbreviations : ALT, AST, BMI, HDL, MRI, NAFLD, PDFF

Plan

Diagnostic Accuracy of ALT Value for NAFLD

Decision Tree for Classification of NAFLD Status

Impact of Using Alternate MRI-PDFF Cut-Points on Prevalence

Discussion

This project was partially supported by the National Institutes of Health (NIH) Grants UL1TR000100 and UL1TR001442. The funders did not participate in the conduct of the study; collection, management, analysis, and interpretation of the data; and preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. M.M. consults for Bracco, Kowa, Median, Merge Healthcare, Novo Nordisk, and Quantitative Insights; is a stockholder with General Electric and Pfizer; and has grant funding from Gilead and Guerbet. C.S. has industry research support from Bayer, GE, Philips, and Siemens; consults for AMRA, Boehringer, and Guerbet; is on the speaker's bureau for Resoundant; and has lab service agreements with Gilead, ICON, Intercept, Shire, and Synageva. The other authors declare no conflicts of interest.