Prevalence of Elevated ALT in U.S. Adolescents

AK Mischel et al. JPGN 2023; 77: 103-109. Prevalence of Elevated ALT in Adolescents in the US 2011–2018

Using NHANES data for 12-19 year olds, the authors examined rates of elevated ALT. Elevated ALT was defined as >22 U/L (females) and >26 U/L (males)  Key findings:

  • Prevalence of elevated ALT in adolescents was 16.5% overall and 39.5% among those with obesity
  • For White (W), Hispanic (H), and Asian (A) adolescents, prevalence of elevated ALT was 15.8%, 21.8%, and 16.5% overall. In overweight adolescents, 12.8% (W), 17.7% (H), and 27.0% (A), and in those with obesity, 43.0% (W), 43.5% (H), and 43.1% (A) in those with obesity, respectively
  • Prevalence was much lower in Black adolescents (10.7% overall, 8.4% for overweight, 20.7% for obesity)
  • Prevalence of ALT at 2X-ULN was 6.6% in adolescents with obesity
  • Hispanic ethnicity, age, male sex, and higher BMI were independent predictors of elevated ALT

My take: It is hard to get very excited about a mildly elevated ALT value when 1 in 6 adolescents has this as well as ~40% of adolescents with obesity.

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Online Aspen Webinar (Part 2) -Abnormal Liver Enzymes in a Tween

What Do Abnormal Liver Enzymes Mean in a Tween William Balistreri

Below I’ve included a few slides and some notes; my notes may have errors of omission or transcription.

Key Points:

  • Provided updated normal reference data for ALT/AST along with patterns of abnormalities
  • Reviewed step-wise workup for teenagers with elevated ALT/AST, particularly fatty liver disease and drug-induced liver disease
  • Increasingly frequent cause of fatty liver disease: psychotropic medications
  • Discussed role/indications of liver biopsy. Liver biopsy is NOT practical option for all children with fatty liver disease and elevated liver enzymes
  • However, ALT values tend to underestimate severity of liver disease