ALT Is an Effective Screening Tool for Advanced Metabolic Dysfunction-Associated Steatotic Liver Disease in Children...

Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in children with obesity and overweight. However, neither the optimal method nor risks and benefits of screening have been established. This study aims to evaluate the effectiveness of an alanine aminotransferase (ALT)-based screening algorithm for detecting those at risk of significant fibrosis.

Children (aged 8-18 years) with (1) obesity or (2) overweight and ≥1 additional risk factor for MASLD were included. Participants were screened for MASLD using ALT and analyzed in 4 groups based on ALT levels. Vibration-controlled transient elastography (VCTE) was performed and analyzed at a threshold of ≥7.4 kPa. Patient features associated with VCTE ≥7.4 kPa were assessed using logistic regression analysis. Diagnostic accuracy of ALT was compared with other noninvasive tests.

Among 322 children (64% male; median age, 13 years; mean body mass index [BMI] z-score 3.5), the prevalence of VCTE ≥7.4 kPa increased significantly with ALT elevation: 1.9% for normal ALT, 16.4% for mild ALT elevation (≥ upper limit of normal [ULN]: female, 22 IU/L; male, 26 IU/L), 21.3% for moderate ALT elevation (≥2 ULN: female, 44-79 IU/L; male, 52-79 IU/L), and 38.9% for significant ALT elevation (≥80 IU/L) (P < .001). Other noninvasive tests did not perform superiorly in this cohort. VCTE ≥7.4 kPa was positively associated with ALT ≥80 IU/L (odds ratio [OR], 2.91; 95% confidence interval [CI], 1.25-6.74), age (OR, 1.50; 95% CI, 1.27-1.76), male gender (OR, 2.37; 95% CI, 1.04-5.40), BMI z-score (OR, 3.01; 95% CI, 1.62-5.61), and Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) (OR, 1.10; 95% CI, 1.00-1.13).

This study shows that ALT is an effective primary screening step for increased liver stiffness, suggestive of significant fibrosis, in children with obesity or overweight and additional risk factors.