Fatty liver in adolescents on the U.S.-Mexico border

To describe the physical and metabolic characteristics of children diagnosed with fatty liver disease in a gastroenterology clinic in El Paso, Texas.

A retrospective chart review of 31 patients aged 8-18 diagnosed with fatty liver was conducted.

These children were diagnosed with fatty liver by elevated alanine aminotransferase (ALT) levels (mean ALT levels 126 +/- 08 U/L) and increased hepatic echogenicity measured via ultrasound. The majority of children were adolescents (12-17 years of age) and Mexican American. All subjects were overweight (body mass index [BMI] > or = 95th percentile) based on Centers for Disease Control and Prevention standards. In a subset of children for whom results from laboratory test were available, we found 40% had high triglycerides (> or = 150 mg/dL), 53% had low high-density lipoprotein cholesterol (< or = 35 mg/dL), and 17% had prediabetes (fasting glucose > or = 100 mg/dL). The clinical and laboratory findings in this patient population with fatty liver are consistent with a diagnosis of nonalcoholic fatty liver disease (NAFLD).

Despite the increasing trend in overweight among children and adolescents, data suggest low rates of diagnosis and management of overweight and related comorbidities by healthcare providers. Overweight has been associated with fatty liver disease in the pediatric population and includes other comorbidities such insulin resistance and features of metabolic syndrome. Screening for overweight in children should constitute the first step in identifying children at risk for NAFLD. Nurse practitioners should include in the evaluation of pediatric patients calculation of BMI and waist circumference for age and screening for other overweight-related comorbidities.