Abstract
Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and affects roughly 10% of children. However, NAFLD is often diagnosed by exclusion - that is, obese children with an elevated alanine aminotransferase (ALT) are screened for other liver diseases in the absence of a biopsy. This testing is nonstandardized, and professional society recommendations differ. This study examines the yield of testing for disorders other than NAFLD in this patient population. A retrospective study was performed in 120 obese, asymptomatic, noncholestatic children with an ALT ≥40 U/L and additional diagnostic testing. No patients were found to have Wilson's, hepatitis A, hepatitis B, hepatitis C, cytomegalovirus, alpha-1 antitrypsin deficiency, autoimmune hepatitis, celiac disease or Epstein-Barr virus. Only one patient (1/120) was identified with definite disease other than NAFLD, which was muscular dystrophy. The positive predictive value of a screening test was 5%, and the specificity was 97%. Of 70 children with an abdominal ultrasound, no significant abnormalities were identified. Extensive testing in asymptomatic, noncholestatic, obese children with an elevated ALT may be of limited diagnostic value and false-positive tests are li...Continue Reading
References
Jan 1, 1996·Journal of Hepatology·A J CzajaS B Moore
Oct 23, 2003·The Journal of Pediatrics·Jeffrey B SchwimmerJoel E Lavine
Sep 7, 2005·Journal of Gastroenterology·Raffaele IorioAngela Vegnente
Oct 4, 2006·Pediatrics·Jeffrey B SchwimmerCynthia Behling
Nov 24, 2006·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·L MorandiA Citterio
Dec 7, 2007·Gastroenterology·Abigail FraserDebbie A Lawlor
Dec 18, 2007·Pediatrics·Sarah E Barlow, UNKNOWN Expert Committee
Jan 19, 2008·American Journal of Preventive Medicine·Steven D StovitzMary T Story
Nov 18, 2008·Gastroenterology·Heather M PattonUNKNOWN Nonalcoholic Steatohepatitis Clinical Research Network
Aug 14, 2009·Seminars in Liver Disease·Giorgina Mieli-Vergani, Diego Vergani
Apr 28, 2011·JAMA : the Journal of the American Medical Association·Joel E LavineUNKNOWN Nonalcoholic Steatohepatitis Clinical Research Network
Jan 19, 2012·JAMA : the Journal of the American Medical Association·Cynthia L OgdenKatherine M Flegal
Mar 8, 2012·Journal of Pediatric Gastroenterology and Nutrition·Pietro VajroValerio Nobili
Jun 5, 2012·Gastroenterology·Naga ChalasaniUNKNOWN American College of Gastroenterologyh
Oct 23, 2012·The Journal of Pediatrics·Jean A WelshMiriam B Vos
Dec 12, 2012·Nutrition, Metabolism, and Cardiovascular Diseases : NMCD·V NobiliG Bedogni
Feb 26, 2013·Journal of Pediatric Gastroenterology and Nutrition·Pietro VajroGiuseppe Giordano
Citations
Apr 20, 2019·Expert Review of Gastroenterology & Hepatology·Anna Di SessaEmanuele Miraglia Del Giudice
Jun 26, 2020·Acta Paediatrica·Ramit Magen-Rimon, Ron Shaoul
Apr 1, 2021·Pediatrics·Toshifumi YodoshiMarialena Mouzaki