A Nomogram for Predicting Non-Alcoholic Fatty Liver Disease in Obese Children

Abstract

Purpose: Non-alcoholic fatty liver disease (NAFLD) ranges in severity from simple steatosis to steatohepatitis. Early detection of NAFLD is important for preventing the disease from progressing to become an irreversible end-stage liver disease. We developed a nomogram that allows for non-invasive screening for NAFLD in obese children. Methods: Anthropometric and laboratory data of 180 patients from our pediatric obesity clinic were collected. Diagnoses of NAFLD were based on abdominal ultrasonographic findings. The nomogram was constructed using predictors from a multivariate analysis of NAFLD risk factors. Results: The subjects were divided into non-NAFLD (n=67) and NAFLD groups (n=113). Factors, including sex, body mass index, abdominal circumference, blood pressure, insulin resistance, and levels of aspartate aminotransferase, alanine aminotransferase (ALT), γ-glutamyl transpeptidase (γGT), uric acid, triglycerides, and insulin, were significantly different between the two groups (all p<0.05) as determined using homeostatis model assessment of insulin resistance (HOMA-IR). In our multivariate logistic regression analysis, elevated serum ALT, γGT, and triglyceride levels were significantly related to NAFLD development. The nomogram was established using γGT, uric acid, triglycerides, HOMA-IR, and ALT as predictors of NAFLD probability. Conclusion: The newly developed nomogram may help predict NAFLD risk in obese children. The nomogram may also allow for early NAFLD diagnosis without the need for invasive liver biopsy or expensive liver imaging, and may also allow clinicians to intervene early to prevent the progression of NAFLD to become a more advanced liver disease.

A Prediction Model of the Incidence of Nonalcoholic Fatty Liver Disease With Visceral Fatty Obesity: A General Population-Based Study

“…Nomograms are widely used as a user-friendly decision-making tool in precision medicine. In a similar manner, Kim et al used γ-glutamyl transpeptidase, homeostatic model assessment of insulin resistance, ALT, uric acid, and TG as the predictors built a nomogram that can be performed to detect for NAFLD in obese children ( 15 ). Earlier studies have shown that the presence of type 2 diabetes, obesity and age are associated with NAFLD and advanced fibrosis ( 1 ).…”

“…Alanine aminotransferase is one of the main liver function tests used to screen for hepatocellular damage and liver dysfunction ( 15 , 21 ). Many studies have showed that ALT was an independent predictor of NAFLD ( 22 ).…”

“…Kim et al build a nomogram to predict NAFLD in obese children ( 15 ). A nomogram is a graphical depiction of an individual predictive models, and although it has been developed for NAFLD in nonobesity adults or obese children, its application in the field of visceral fatty obesity is rare ( 15 , 16 ). The objective of this research was to identify NAFLD early by simply noninvasive indicators and an online calculator to accurately detect earlier NAFLD in patients with visceral fatty obesity.…”

“…Recently, Zhou et al established a nomogram to identify the earlier stage of liver fibrosis to avoid liver injury ( 14 ). Kim et al build a nomogram to predict NAFLD in obese children ( 15 ). A nomogram is a graphical depiction of an individual predictive models, and although it has been developed for NAFLD in nonobesity adults or obese children, its application in the field of visceral fatty obesity is rare ( 15 , 16 ).…”