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Nonalcoholic Fatty Liver Disease in Young Children with Obesity
Corie Klepper1, Nancy A Crimmins2,3, Sarah Orkin1,3
1Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Suspected nonalcoholic fatty liver disease (NAFLD) affects 35% of obese children aged 2-6 years, predicted by obesity severity and gamma-glutamyl transferase (GGT). Early screening is crucial for intervention.
Area of Science:
- Pediatrics
- Hepatology
- Metabolic Disorders
Background:
- Nonalcoholic fatty liver disease (NAFLD) is a growing concern in pediatric populations.
- Obesity is a primary risk factor for NAFLD development.
- Early identification of NAFLD in young children is essential for timely intervention.
Purpose of the Study:
- To determine the prevalence of suspected NAFLD in obese children aged 2-6 years.
- To identify risk factors associated with elevated liver enzymes in this cohort.
- To highlight the need for early screening and diagnosis of NAFLD in early childhood.
Main Methods:
- Retrospective single-center study involving 237 children aged 2-6 years with obesity.
- Suspected NAFLD defined by alanine aminotransferase (ALT) >30 U/L.
- Multivariable analyses conducted to identify predictors of elevated ALT.
Main Results:
- 35% of the children exhibited elevated ALT levels.
- Higher BMI z-score (OR: 1.5) and gamma-glutamyl transferase (GGT) (OR: 21.3) were significant predictors of elevated ALT.
- 38% of children with multiple ALT measurements showed persistently elevated levels; only 7% received further testing for alternative liver conditions.
Conclusions:
- Suspected NAFLD is prevalent in young obese children, with obesity severity and GGT as key predictors.
- NAFLD may develop before other cardiometabolic comorbidities, underscoring the importance of early detection.
- Prompt diagnosis and intervention through earlier screening can potentially prevent or delay serious health consequences in adolescence and adulthood.
Abstract:
To evaluate the prevalence of suspected nonalcoholic fatty liver disease (NAFLD) in young children with obesity and determine associated risk factors. Retrospective single-center study of children with obesity, ages 2-6 years. Suspected NAFLD was defined as an alanine aminotransferase (ALT) >30 U/L. Multivariable analyses were performed to determine predictors of elevated ALT. Among 237 children 2-6 years old, 35% had elevated ALT. Multivariable analysis showed that higher BMI z score [odds ratio (OR): 1.5 confidence interval (95% CI: 1.04-1.92)] and higher gamma-glutamyl transferase (GGT) [OR: 21.3 (95% CI: 3.7-121.1)] predicted elevated ALT. Of those with ≥2 ALT levels, 38% (n = 33/86) had a persistently elevated ALT (median ALT >30 U/L). Only 7% of patients with ALT >30 U/L underwent further testing to evaluate for alternative causes of liver disease. Suspected NAFLD is common in young children with obesity and predicted by obesity severity and GGT. Other cardiometabolic markers were equivalent between those with normal vs. elevated ALT, suggesting NAFLD onset may precede development of comorbidities. Earlier screening will enable prompt diagnosis and intervention, which may prevent or delay the onset of cardiometabolic diseases commonly associated with NAFLD in adolescence and adulthood.
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