Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Pediatr Gastroenterol Nutr. 2024 Aug;79(2):229-237. doi: 10.1002/jpn3.12230. Epub 2024 May 1.
To apply the new nomenclature for steatotic liver diseases (SLD), replacing nonalcoholic fatty liver disease (NAFLD) with metabolic dysfunction-associated steatotic liver disease (MASLD), in adolescents using National Health and Nutrition Examination Survey (NHANES) data.
Among 1410 adolescents (12-19 years) in NHANES (2017-March, 2020), the controlled attenuation parameter (CAP) of transient elastography (TE) was used to define steatosis and fibrosis (TE ≥ 7.4 kPa). Obesity and alanine aminotransferase (ALT) ≥ 80 U/L were used to identify adolescents qualifying for hepatology referral according to practice guidelines. NAFLD was defined as liver steatosis without a specific exposure; it has no cardiometabolic risk factor requirement, unlike MASLD.
Steatosis (yes/no) is the first decision point in the new diagnostic protocol; however, criteria for steatosis are undefined. At the supplier (EchoSens)-recommended CAP threshold of 240 dB/m, 30.5% (95% confidence interval [CI]: 27.1%-34.0%) of adolescents had SLD and about 85% of adolescents with NAFLD met criteria for MASLD. The other 15% would receive an ambiguous diagnosis of either cryptogenic SLD or possible MASLD. At higher CAP thresholds, MASLD/NAFLD concordance increased and approached 100%. Among adolescents with MASLD-fibrosis, only 8.8% (95% CI: 0%-19.3%) had overweight/obese and ALT ≥ 80 U/L.
The new nomenclature highlights the high prevalence of liver steatosis. At the CAP threshold of 240 dB/m, however, approximately 15% of adolescents would receive an ambiguous diagnosis, which could lead to confusion and worry. Fewer than 10% of adolescents with MASLD-fibrosis had overweight/obese and ALT ≥ 80 U/L. Revised guidelines are needed to ensure that the other 90% receive appropriate referral and liver disease care.
应用新的脂肪性肝病命名法，将代谢相关脂肪性肝病（MASLD）取代非酒精性脂肪性肝病（NAFLD），并基于国家健康和营养调查（NHANES）数据对青少年进行研究。
在 NHANES（2017 年 3 月至 2020 年）中，对 1410 名（12-19 岁）青少年进行了瞬时弹性成像（TE）的受控衰减参数（CAP）检测，以定义脂肪变性和纤维化（TE≥7.4kPa）。肥胖和丙氨酸氨基转移酶（ALT）≥80U/L 用于根据实践指南确定符合肝科转诊条件的青少年。NAFLD 被定义为无特定暴露的肝脏脂肪变性；它没有代谢相关心血管危险因素的要求，这与 MASLD 不同。
脂肪变性（有/无）是新诊断方案的第一个决策点，但脂肪变性的标准尚未确定。在供应商（EchoSens）推荐的 CAP 阈值 240dB/m 下，30.5%（95%置信区间[CI]：27.1%-34.0%）的青少年患有 SLD，大约 85%的患有 NAFLD 的青少年符合 MASLD 的标准。其余 15%的患者将得到不确定的隐匿性 SLD 或可能的 MASLD 诊断。在更高的 CAP 阈值下，MASLD/NAFLD 的一致性增加，并接近 100%。在患有 MASLD-纤维化的青少年中，仅有 8.8%（95%CI：0%-19.3%）存在超重/肥胖和 ALT≥80U/L。
新的命名法突出了肝脏脂肪变性的高患病率。然而，在 CAP 阈值 240dB/m 下，大约 15%的青少年会得到不确定的诊断，这可能会导致困惑和担忧。在患有 MASLD-纤维化的青少年中，仅有不到 10%的患者存在超重/肥胖和 ALT≥80U/L。需要修订指南，以确保其余 90%的患者得到适当的转诊和肝脏疾病护理。
