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Evaluation of Hepatitis in Pediatric Patients With Presumed Nonalcoholic Fatty Liver Disease
Fat'hiya Al-Harthy1, Neha Kamath2, Lee Hill3,4
1From the Department of Pediatrics, Division of Gastroenterology and Nutrition, McMaster University, Hamilton, Canada.
Insights
Many children with suspected nonalcoholic fatty liver disease (NAFLD) show signs of other liver conditions. Comprehensive testing for alternate diagnoses was infrequent, highlighting the need for broader evaluation in pediatric liver disease.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Clinical Practice Guidelines
Background:
- Nonalcoholic fatty liver disease (NAFLD) is increasingly diagnosed in children.
- Clinical practice guidelines for NAFLD diagnosis were published in 2017.
- Evaluation of pediatric patients often presumes NAFLD based on initial findings.
Purpose of the Study:
- To assess the frequency of investigations suggesting alternate etiologies for chronic hepatitis in children with suspected NAFLD.
- To evaluate adherence to 2017 clinical practice guidelines for NAFLD diagnosis.
- To determine the rate of comprehensive testing for other liver diseases in this pediatric cohort.
Main Methods:
- Retrospective chart review of patients (8–17 years) evaluated for suspected NAFLD from 2017-2020.
- Inclusion criteria: BMI >85%, elevated alanine aminotransferase, and radiographic steatosis.
- Review of bloodwork and diagnostic workups for liver disease.
Main Results:
- Ninety-five patients met inclusion criteria.
- Abnormal bloodwork requiring further testing was identified in 28.4% of patients.
- A different chronic liver disease was diagnosed in 11.6%, with only 9.5% receiving comprehensive additional bloodwork.
Conclusions:
- A significant proportion of children evaluated for NAFLD exhibited bloodwork suggesting alternate diagnoses.
- Comprehensive diagnostic workups for other liver diseases were infrequently performed.
- Maintaining a differential diagnosis is crucial for children presumed to have NAFLD.
Abstract:
In 2017, the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition published clinical practice guidelines for the assessment and diagnosis of nonalcoholic fatty liver disease (NAFLD). We determined how frequently these investigations suggest an alternate etiology for chronic hepatitis in 8- to 17-year-old patients with body mass index >85%, elevated alanine aminotransferase and radiographic steatosis, and rates of adherence to 2017 guidelines.
Methods:
We conducted a retrospective chart review of patients presenting to McMaster Children's Hospital from 2017-2020 for evaluation of suspected NAFLD. Bloodwork was reviewed.
Results:
Ninety-five patients met inclusion criteria. Abnormal bloodwork that required further testing was found in 28.4%; a different chronic liver disease was ultimately diagnosed in 11.6%. Only 9.5% received comprehensive, additional bloodwork for other causes of liver disease.
Conclusion:
A high proportion of patients evaluated for suspected NAFLD had bloodwork possibly suggesting an alternate diagnosis. Comprehensive testing was infrequently performed. These results reinforce the importance of maintaining a differential diagnosis among children presumed to have NAFLD.
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