Department of Pediatrics, University of Kentucky College of Medicine and Kentucky Children's Hospital, Lexington, Kentucky, USA.
Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA.
Pediatr Obes. 2022 Mar;17(3):e12862. doi: 10.1111/ijpo.12862. Epub 2021 Oct 18.
An increasing number of clinical practice guidelines recommend screening children with obesity for non-alcoholic fatty liver disease (NAFLD). However, there is limited evidence regarding what parameters should be used to initiate the screening.
The objective of this study was to determine whether obesity class rather than age group can identify a higher percent of children at risk of NAFLD as assessed by abnormal alanine aminotransferase (ALT).
This is a cross-sectional study in a regional referral clinic for evaluation of obesity. Children were stratified by age group or by obesity class, and data obtained at first visit were analysed.
Of the 784 children, 482 were ≥10, 209 were 6 to 9 and 93 were 2 to 5 years of age. Abnormal ALT was observed in 32.1%, 46.9% and 61.0% of children with class I, II or III obesity, respectively (p < 0.001), while the risk of abnormal ALT did not differ in very young (2-5), young (6-9), or children older than 10 years. A multivariable analysis showed that class II and class III obesity were associated with 2.1-fold (1.27-3.72) and 4-fold (2.41-6.96) greater odds of abnormal ALT compared with class I obesity. African-American children had lower risk of abnormal ALT (0.27), whereas Hispanic children had higher risk (2.37). Obesity class was a better predictor of abnormal ALT than age, especially in girls. Furthermore, 66.7% of boys (p = 0.009) and 69% of girls (p < 0.001) with abnormal ALT exhibited additional signs of metabolic dysfunction.
Obesity class is more strongly associated with abnormal ALT than age.
越来越多的临床实践指南建议对肥胖儿童进行非酒精性脂肪性肝病（NAFLD）筛查。然而，关于应该使用哪些参数来启动筛查，目前证据有限。
本研究旨在确定肥胖程度而非年龄组是否可以通过异常丙氨酸氨基转移酶（ALT）来识别更多患有 NAFLD 的儿童。
这是在一家区域性肥胖评估转诊诊所进行的横断面研究。儿童按年龄组或肥胖程度分层，分析首次就诊时获得的数据。
在 784 名儿童中，482 名年龄≥10 岁，209 名年龄为 6 至 9 岁，93 名年龄为 2 至 5 岁。I 类、II 类或 III 类肥胖儿童的异常 ALT 分别为 32.1%、46.9%和 61.0%（p<0.001），而非常年幼（2-5 岁）、年幼（6-9 岁）或年龄大于 10 岁的儿童之间的异常 ALT 风险没有差异。多变量分析显示，与 I 类肥胖相比，II 类和 III 类肥胖与异常 ALT 的比值比分别为 2.1 倍（1.27-3.72）和 4 倍（2.41-6.96）。非裔美国儿童异常 ALT 的风险较低（0.27），而西班牙裔儿童的风险较高（2.37）。肥胖程度比年龄更能预测异常 ALT，尤其是在女孩中。此外，66.7%的男孩（p=0.009）和 69%的女孩（p<0.001）的异常 ALT 伴有其他代谢功能障碍的迹象。
肥胖程度与异常 ALT 的相关性强于年龄。
