Challenges in Screening for Pediatric Nonalcoholic Fatty Liver Disease

Area of Science:

• Pediatric Gastroenterology
• Hepatology
• Obesity Medicine

Background:

• Nonalcoholic fatty liver disease (NAFLD) is a leading cause of elevated liver enzymes in US children.
• Published guidelines recommend NAFLD screening for children with obesity.
• The implementation of these recommendations in pediatric weight management settings is not well-defined.

Purpose of the Study:

• To characterize NAFLD screening practices within a large pediatric weight management program.
• To assess the rate of elevated liver enzymes and subsequent diagnostic steps in this cohort.

Main Methods:

• Retrospective chart review of patients in a pediatric weight management program during 2014.
• Analysis of liver enzyme panels and follow-up laboratory testing.
• Inclusion criteria: patients seen in the program, liver enzyme data available.

Main Results:

• A total of 1312 patients were evaluated; liver enzyme panels were obtained for 847 (64.5%).
• 5.5% (47/847) had liver enzymes elevated twice the upper limit of normal.
• Of those with elevated enzymes, 70% (33/47) had persistent elevations, and 67% (22/33) underwent further exclusionary testing.

Conclusions:

• Screening for NAFLD in pediatric weight management programs presents significant challenges.
• Adherence to recommended exclusionary testing for elevated liver enzymes is suboptimal.
• Barriers preventing completion of further diagnostic evaluations require identification and intervention.