A recent study (P Kumar et al. JPGN 2018; 67: 75-9) examined suspected NAFLD in 12 to 18 year olds using data from NHANES. In the analysed cohort, there were 124 suspected NAFLD and 1385 without suspicion of NAFLD. This subset was weight to represent a U.S. population of over 18 million.
- Suspected NAFLD was defined by abnormal ALT (>25.8 U/L for boys and >22.1 U/L for girls) who did not have another explanation (eg. viral hepatitis, medication)
- Lean BMI was defined by BMI less than 85th% for age
- Hypertriglyceridemia ≥ 150
- Low HDL ≤ 40 mg/dL
- HOMA-IR =fasting glucose x insulin (microU/mL) divided by 405. Insulin resistance was defined as HOMA-IR ≥ 3
- Suspected NAFLD affects ~8% of lean adolescents in the U.S.
- Hypertriglyceridemia was noted in 10 of 124 suspected NAFLD and was a risk factor (P=0.028) as was Low HDL which occurred in 15 (P=0.016) and IR which occurred in 43 (P=0.053)
My take: Elevated ALT, a marker for fatty liver disease, is common even in adolescents without obesity. Elevated triglycerides, low HDL, and insulin resistance are all risk factors for suspected NAFLD in non-overweight/non-obese teens.
Related blog posts:
- NAFLD Guidance from American Association for the Study of Liver Diseases
- Pediatric NAFLD Guidelines 2017
- Concise Review: Fatty Liver in Pediatrics
- Ultrasound Unreliable to Exclude Fatty Liver
- A liver disease tsunami | gutsandgrowth
- Increasing prevalence of pediatric NAFLD | gutsandgrowth