Department of Medicine and RehabilitationPoliclinico di MonzaMonzaItaly.
Department of Medicine and SurgeryUniversity of Milano BicoccaMilanItaly.
Hepatol Commun. 2022 Aug;6(8):2070-2078. doi: 10.1002/hep4.1969. Epub 2022 Apr 26.
Recently, an expert panel proposed diagnostic criteria for metabolic dysfunction-associated fatty liver disease (MAFLD) in the pediatric population. The aim of this study was to evaluate the prevalence of MAFLD among US adolescents and to investigate whether the new MAFLD definition is able to identify individuals with more advanced liver disease. We analyzed data from participants 12-18 years old included in the 2017-2020 cycles of the National Health and Nutrition Examination Survey, a large survey aimed at including individuals representative of the non-institutionalized general US population. Participants with a complete vibration-controlled transient elastography exam were included. Steatosis was evaluated through the median controlled attenuation parameter (CAP) and fibrosis through median liver stiffness measurement (LSM). Recently proposed criteria for the diagnosis of MAFLD were applied. Multivariable logistic regression analysis was performed to evaluate the impact of the new MAFLD definition on the odds of significant liver fibrosis. We included a total of 1446 adolescents (mean age: 14.9 years; 52.0% male; 47.3% overweight or obese). No participant reported a previous history of viral hepatitis. Steatosis (CAP ≥ 248 dB/m) was present in 25.9% (95% confidence interval [CI] 23.3-28.9) of individuals, and among these, 87.7% met the MAFLD criteria. Only 22.9% of patients with steatosis had elevated alanine aminotransferase levels. Among participants with steatosis, prevalence of significant liver fibrosis (LSM ≥ 7.4 kPa) did not differ significantly according to whether they met MAFLD criteria (9.7% vs. 15.2%, p = 0.276). In the multivariable model, odds of significant fibrosis did not differ significantly between these two groups. MAFLD criteria are met by most US adolescents with elastographic evidence of steatosis. Nonetheless, these criteria do not appear to improve detection of subjects with more advanced liver disease. Further longitudinal studies are needed to evaluate whether metabolic dysfunction is associated with faster progression toward inflammation, fibrosis, and liver-related events.
最近，一个专家小组提出了代谢功能障碍相关脂肪性肝病（MAFLD）在儿科人群中的诊断标准。本研究旨在评估 MAFLD 在美 国青少年中的流行率，并探讨新的 MAFLD 定义是否能够识别出患有更严重肝病的个体。我们分析了 2017-2020 年全国健康和营养调查（一项旨在包括非机构化普通美 国人群代表性个体的大型调查）中 12-18 岁参与者的数据。纳入了完成振动控制瞬态弹性成像检查的参与者。通过中位受控衰减参数（CAP）评估脂肪变性，通过中位肝硬度测量（LSM）评估纤维化。应用了最近提出的 MAFLD 诊断标准。进行多变量逻辑回归分析，以评估新的 MAFLD 定义对显著纤维化几率的影响。我们共纳入了 1446 名青少年（平均年龄：14.9 岁；52.0%为男性；47.3%超重或肥胖）。没有参与者报告有先前的病毒性肝炎病史。脂肪变性（CAP≥248dB/m）在 25.9%（95%置信区间[CI]23.3-28.9）的个体中存在，其中 87.7%符合 MAFLD 标准。只有 22.9%有脂肪变性的患者丙氨酸氨基转移酶水平升高。在有脂肪变性的参与者中，根据是否符合 MAFLD 标准，显著纤维化（LSM≥7.4kPa）的患病率无显著差异（9.7%比 15.2%，p=0.276）。在多变量模型中，这两组之间显著纤维化的几率没有显著差异。有弹性成像证据的脂肪变性的大多数美 国青少年符合 MAFLD 标准。尽管如此，这些标准似乎并不能提高对更严重肝病患者的检出率。需要进一步的纵向研究来评估代谢功能障碍是否与炎症、纤维化和与肝脏相关的事件更快进展有关。
