Original ArticleHistological Abnormalities in Children with Nonalcoholic Fatty Liver Disease and Normal or Mildly Elevated Alanine Aminotransferase Levels
Section snippets
Methods
The pediatric NAFLD studies were designed by subcommittees of the NASH CRN Steering Committee, composed of principal investigators from each clinical site, the 2 co-chairs of the Pathology Committee, the principal investigator from the Data Coordinating Center, and the NIDDK scientific officer. After approval by the Steering Committee, the study was approved by the Institutional Review Board at each site. Enrolled patients and their guardians provided written informed assent and consent. The
Results
Among the 483 children aged 5-18 enrolled in the 2 NASH CRN database studies between October 2004 and January 2013, 91 children had a normal or mildly elevated ALT level with a centrally reviewed liver biopsy specimen obtained within 180 days of baseline ALT measurement. Thirty-two of these 91 children (35%) were enrolled in the NAFLD Database Study, and 59 (65%) were enrolled in the NAFLD Pediatric Database 2 Study. Among the comparison group of 392 children, 11% were enrolled in the NAFLD
Discussion
NAFLD is the most common chronic liver disease in the pediatric population, occurring in 9.6% of children overall and in up to 38% of obese children.3, 11 Liver disease can range from isolated hepatic steatosis to steatohepatitis with active inflammation to cirrhosis.9 Ultrasonography is a commonly used noninvasive technique in steatosis screening, but has only a moderate positive predictive value, does not detect all cases, and reflects fat and sometimes fibrosis, but not inflammation or
References (21)
- et al.
Pediatric nonalcoholic fatty liver disease in 2009
J Pediatr
(2009) - et al.
Nonalcoholic fatty liver disease in the pediatric population
Clin Liver Dis
(2004) - et al.
Prevelance of abnormal serum aminotransferase values in overweight and obese adolescents
J Pediatr
(2000) - et al.
Treatment of nonalcoholic fatty liver disease in children: TONIC trial design
Contemp Clin Trials
(2010) - et al.
Nonalcoholic fatty liver disease in children: a single center experience
Clin Gastroenterol Hepatol
(2008) - et al.
Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values
Hepatology
(2003) - et al.
Clinical correlates of histopathology in pediatric nonalcoholic steatohepatitis
Gastroenterology
(2008) Expert Committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report
Pediatrics
(2007)- et al.
SAFETY study: alanine aminotransferase cutoff values are set too high for reliable detection of pediatric chronic liver disease
Gastroenterology
(2010) - et al.
Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease
Hepatology
(2010)
Cited by (139)
Special Population: Pediatric Nonalcoholic Fatty Liver Disease
2023, Clinics in Liver DiseaseFatty Liver Disease
2023, MacSween's Pathology of the Liver, Eighth EditionUpdated upper limits of normal serum alanine aminotrasferase levels for screening metabolic dysfunction-associated fatty liver disease in obese children
2022, Journal of the Formosan Medical AssociationEffect of pharmacological interventions and placebo on liver Histology in nonalcoholic steatohepatitis: A network meta-analysis
2022, Nutrition, Metabolism and Cardiovascular DiseasesNonalcoholic Steatohepatitis in Children
2022, Clinics in Liver DiseaseVoluntary physical activity in early life attenuates markers of fatty liver disease in adult male rats fed a high-fat diet
2023, British Journal of Nutrition
Supported by the NIDDK (U01DK061718, U01DK061728, U01DK061731, U01DK061732, U01DK061734, U01DK061737, U01DK061738, U01DK061730, U01DK061713) and the National Institute of Child Health and Human Development. Several clinical centers use support from General Clinical Research Centers or Clinical and Translational Science Awards in conduct of NASH CRN Studies (UL1RR024989, UL1RR025761, M01RR00188, UL1RR024131, UL1RR025014, UL1RR031990, UL1RR025741, UL1RR029887, UL1RR24156, UL1RR025055, and UL1RR031980). The authors declare no conflicts of interest.
Registered with ClinicalTrials.gov: NCT01061684
- ∗
List of members of the NASH CRN is available at www.jpeds.com (Appendix).