Department of Paediatric Gastroenterology and Nutrition, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands.
Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands.
Acta Paediatr. 2022 Dec;111(12):2408-2415. doi: 10.1111/apa.16502. Epub 2022 Aug 7.
To evaluate the feasibility of screening for non-alcoholic fatty liver disease (NAFLD) in clinical practice and the acceptance of a screening strategy, and to identify factors that determine compliance.
A screening protocol, based on alanine aminotransferase measurement and introduced to healthcare workers of Dutch outpatient obesity clinics in 2017, was evaluated. Medical files of children who visited the largest outpatient obesity clinic between 2017 and 2020 were evaluated. Focus group discussions (FGDs) were conducted with 14 healthcare workers who had been using the screening protocol.
Screening for NAFLD was performed in 477/571 (84%) of the children. Loss of follow-up was the major reason for inadequate screening. Follow-up was performed in 81/134 children with an abnormal screening result (61%). The FGDs indicated 13 barriers for screening, regarding guideline- and knowledge-related issues.
Screening for NAFLD was performed in the vast majority of the children. However, adherence to the guideline after an abnormal initial screening result needs to be improved. This can be achieved by improving the loss of follow-up of patients' and physicians' awareness of the relevance of mildly elevated ALT levels.
评估在临床实践中筛查非酒精性脂肪性肝病（NAFLD）的可行性和对筛查策略的接受程度，并确定决定依从性的因素。
评估了 2017 年向荷兰门诊肥胖诊所的医疗保健工作者引入的基于丙氨酸氨基转移酶测量的筛查方案。评估了 2017 年至 2020 年间访问最大门诊肥胖诊所的儿童的医疗档案。对 14 名使用筛查方案的医疗保健工作者进行了焦点小组讨论（FGD）。
对 571 名儿童中的 477 名（84%）进行了 NAFLD 筛查。失访是筛查不充分的主要原因。对 134 名筛查结果异常的儿童中的 81 名（61%）进行了随访。FGD 表明筛查存在 13 个障碍，涉及指南和知识相关问题。
对绝大多数儿童进行了 NAFLD 筛查。然而，需要提高对异常初始筛查结果的指南遵循性。这可以通过提高患者和医生对轻度升高的 ALT 水平相关性的认识来实现。
