Related Experiment Video
Updated: Jan 31, 2026
Multidisciplinary Approach to Obesity Management: A Case Report
Published on: May 30, 2025
Interventions to improve liver enzyme screening testing in obese patients aged <18 years in a public hospital,
Megan Ward1, Peter Nguyen1, Simi Akintorin2
1Department of Pediatrics, Cook County Health, and Hospitals System, The John H. Stroger Jr. Hospital, Chicago, IL, USA, ksoyemi@cookcountyhhs.org.
Insights
Liver enzyme screening testing (LEST) for pediatric nonalcoholic fatty liver disease (NAFLD) remains low, even after provider interventions. Further education is crucial to improve early detection and prevent severe liver complications in obese children.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Public Health
Background:
- Obesity is a primary risk factor for pediatric nonalcoholic fatty liver disease (NAFLD).
- Early detection of NAFLD through liver enzyme screening testing (LEST) is critical for preventing severe liver disease.
- Current LEST rates in at-risk pediatric populations require evaluation and improvement.
Purpose of the Study:
- To determine baseline LEST rates in obese pediatric patients at risk for NAFLD.
- To assess the impact of a system-wide provider intervention on LEST rates.
- To identify strategies for enhancing LEST in pediatric NAFLD prevention.
Main Methods:
- Retrospective electronic medical record review of pediatric patient encounters (ages 2-18).
- Bi-phased analysis comparing LEST rates pre- and post-intervention.
- Intervention included staff education, reminders, and informational materials.
Main Results:
- Pre-intervention LEST rate was 24/100 encounters, increasing to 28/100 encounters post-intervention.
- Overweight/obese children showed significantly higher LEST rates compared to normal-weight peers both pre- and post-intervention.
- Despite interventions, LEST rates indicate a need for further improvement in screening adherence.
Conclusions:
- LEST rates in obese pediatric patients at risk for NAFLD are suboptimal.
- Provider education and targeted interventions are necessary but insufficient alone to optimize LEST.
- Enhanced strategies are essential to improve LEST and mitigate long-term liver disease risks in children.
Introduction:
Our study objective was to determine the health care provider liver enzyme screening testing (LEST) rates in obese pediatric patients at risk for nonalcoholic fatty liver disease (NAFLD), with the goal of improving NAFLD LEST after specific system-wide provider intervention.
Methods:
We conducted a bi-phased retrospective electronic medical record review of health care practitioner encounters to determine LEST in overweight/obese (body mass index≥25) patients between ages 2 and 18 years in our outpatient clinics. Intervention activities included lectures to staff and residents, fliers distributed to providers, monthly email reminders, and computer stickers placed on all terminals. From both phases, samples of simple random samples were drawn from the selected electronic medical records and reviewed for LEST screening; after intervention from this pool of patients, a random sample was chosen for LEST rate analysis. LEST rates were calculated per 100 patient encounters.
Results:
We screened 2,979 and 2,634 pre and postintervention pediatric encounters from which we obtained a simple random sample of patients for LEST analysis. Overall of the 264 preintervention patients, 65 (24.4%) patients received LEST translating to 24/100 encounters. Of the 65 who received screening, 53 (81%) were classified as overweight/obese. Screening rate was higher for overweight/obese patients (32/100 encounters), when compared with normal weight patients' crude OR 3.8 (11/100 encounters; 95% CI: 1.9-7.6, P<0.005). Of the 242 postintervention patients, 70 (28%) received LEST translating to 28/100 encounters; of these, 58 (82%) were classified as overweight/obese with a rate of 42/100 encounters compared with 11/100 encounters for normal weight patients' crude OR 5.5 (95% CI: 2.8-7.5, P<0.005).
Conclusion:
Obesity is a significant risk factor for NAFLD; one in four obese pediatric patients had LEST. Additional health care practitioner education and interventions are needed to improve LEST to prevent long-term complications such as liver cirrhosis or failure.
Related Concept Videos
01:21Drug Dosing: Obese Patients
00:59Hospitals-II
Nurses that work in...
01:28Hospitals-I
01:25Pharmacokinetics in Obese Patients: Drug Absorption and Distribution
01:20Pharmacokinetics in Obese Patients: Drug Metabolism and Excretion
01:27Pharmacodynamics in Geriatric Patients: Effects of Age