Predictors of pediatric non-alcoholic fatty liver disease (NAFLD) in obese children and adolescents: Is serum ALT level sufficient in detecting NAFLD?

INTRODUCTION: The prevalence of obesity and related comorbidities is increasing in children and adolescents. This study aimed to specify the prevalence of non-alcoholic fatty liver disease (NAFLD) in obese children and adolescents and to identify the predictive factors associated with NAFLD.
METHODS: Obese children and adolescents aged 6 to 18 years were included in the study. The presence and degree of hepatosteatosis were evaluated using liver US. The groups with and without NAFLD were compared in terms of demographic, anthropometric, and biochemical parameters.
RESULTS: One hundred fifty-five obese children and adolescents with a median age of 13.8 (4.93) years (43 males, 131 pubertal) were included in the study. We found that 57.4% of obese cases had NAFLD. In the group with NAFLD, serum ALT level, AST level, HOMA-IR, and triglyceride level were significantly higher (p<0.001, p<0.001, p=0.015, p=0.021, respectively), and serum HDL-C level was significantly lower (p=0.001) compared to the group without NAFLD. In the binomial logistic regression analysis, age (β=0.213, OR=1.23, p=0.040) and serum ALT level (β=0.047, OR=1.04, p=0.011) were determining factors for hepatosteatosis. The diagnostic accuracy of elevated serum ALT level in detecting NAFLD was found to be 65.8% with a sensitivity of 77.3% and a specificity of 57.3% (+LR 1.81 and -LR 0.40).
DISCUSSION AND CONCLUSION: The prevalence of NAFLD determined with US in obese children and adolescents was 57.4%. Age and serum ALT level were found to be predictive factors for hepatosteatosis. Increased ALT alone shows insufficient performance in detecting NAFLD.