Evaluation of the feasibility of screening for paediatric non-alcoholic fatty liver disease

AIM

To evaluate the feasibility of screening for non-alcoholic fatty liver disease (NAFLD) in clinical practice and the acceptance of a screening strategy, and to identify factors that determine compliance.

METHODS

A screening protocol, based on alanine aminotransferase measurement and introduced to healthcare workers of Dutch outpatient obesity clinics in 2017, was evaluated. Medical files of children who visited the largest outpatient obesity clinic between 2017 and 2020 were evaluated. Focus group discussions (FGDs) were conducted with 14 healthcare workers who had been using the screening protocol.

RESULTS

Screening for NAFLD was performed in 477/571 (84%) of the children. Loss of follow-up was the major reason for inadequate screening. Follow-up was performed in 81/134 children with an abnormal screening result (61%). The FGDs indicated 13 barriers for screening, regarding guideline- and knowledge-related issues.

CONCLUSION

Screening for NAFLD was performed in the vast majority of the children. However, adherence to the guideline after an abnormal initial screening result needs to be improved. This can be achieved by improving the loss of follow-up of patients' and physicians' awareness of the relevance of mildly elevated ALT levels.

Possible prediction of obesity-related liver disease in children and adolescents using indices of body composition

BACKGROUND

Diagnosis of nonalcoholic fatty liver disease in children and adolescents currently requires advanced or invasive technologies.

OBJECTIVES

We aimed to develop a method to improve diagnosis, using body composition indices and liver biochemical markers.

METHODS

To diagnose non-alcoholic fatty liver disease, 767 Danish children and adolescents underwent clinical examination, blood sampling, whole-body dual-energy X-ray absorptiometry scanning and proton magnetic resonance spectroscopy for liver fat quantification. Fourteen variables were selected as a starting point to construct models, narrowed by stepwise selection. Individuals were split into a training set for model construction and a validation test set. The final models were applied to 2120 Danish children and adolescents to estimate the prevalence.

RESULTS

The final models included five variables in different combinations: body mass index-standard deviation score, android-to-gynoid-fat ratio, android-regional fat percent, trunk-regional fat percent and alanine transaminase. When validated, the sensitivity and specificity ranged from 38.6% to 51.7% and 87.6% to 91.9%, respectively. The estimated prevalence was 24.2%-35.3%. Models including alanine transaminase alongside body composition measurements displayed higher sensitivity.

CONCLUSIONS

Body composition indices and alanine transaminase can be used to estimate non-alcoholic fatty liver disease, with 38.6%-51.7% sensitivity and 87.6%-91.9%, specificity, in children and adolescents with overweight (including obesity). These estimated a 24.2%-35.3% prevalence in 2120 patients.