Accuracy of prediction scores and novel biomarkers for predicting nonalcoholic fatty liver disease in obese children

Abstract

Background:Accurate prediction scores for liver steatosis are demanded to enable clinicians to noninvasively screen for nonalcoholic fatty liver disease (NAFLD). Several prediction scores have been developed, however external validation is lacking.Objective:The aim was to determine the diagnostic accuracy of four existing prediction scores in severely obese children, to develop a new prediction score using novel biomarkers and to compare these results to the performance of ultrasonography.Design and Results:Liver steatosis was measured using proton magnetic resonance spectroscopy in 119 severely obese children (mean age 14.3 ± 2.1 years, BMI z‐score 3.35 ± 0.35). Prevalence of steatosis was 47%. The four existing predictions scores (“NAFLD liver fat score,” “fatty liver index,” “hepatic steatosis index,” and the pediatric prediction score) had only moderate diagnostic accuracy in this cohort (positive predictive value (PPV): 70, 61, 61, 69% and negative predictive value (NPV) 77, 69, 68, 75%, respectively). A new prediction score was built using anthropometry, routine biochemistry and novel biomarkers (leptin, adiponectin, TNF‐alpha, IL‐6, CK‐18, FGF‐21, and adiponutrin polymorphisms). The final model included ALT, HOMA, sex, and leptin. This equation (PPV 79% and NPV 80%) did not perform substantially better than the four other equations and did not outperform ultrasonography for excluding NAFLD (NPV 82%).Conclusion:The conclusion is in severely obese children and adolescents existing prediction scores and the tested novel biomarkers have insufficient diagnostic accuracy for diagnosing or excluding NAFLD.

Acanthosis nigricans in obese Chinese children

“…Several prediction scores have been developed for non-invasive liver steatosis screening, but they have insufficient diagnostic accuracy among obese children. 36 For DM, incidence, prevalence, and disease progression are believed to vary in different ethnic groups. The overall frequency of abnormal glucose homeostasis of 10% (8% impaired glucose tolerance and 2% with DM; data not shown) was lower than in a recent study by Brickman et al 16 who reported a 29% frequency of abnormal glucose homeostasis among a group of 8-to-14 years old, mainly of Hispanic and African American children with AN.…”

Intensive lifestyle treatment for non-alcoholic fatty liver disease in children with severe obesity: inpatient versus ambulatory treatment

“…14 Details on these measurements were previously reported. 15 1 H-MRS determined liver steatosis and serum ALT were the primary outcome measures in this study. Treatment success was defined as absence of steatosis and/or normal ALT levels.…”

Predictors of Metabolic Risk in Childhood Obesity

“…However, large-scale abdominal ultrasounds may not be a cost-effective approach. Several circulating biomarkers and composite clinical scores including both clinical and circulating variables have been proposed as screening tools for NAFLD, but none of them proved to have higher accuracy and cost-effectiveness than ultrasounds [62]. Biopsy is also the gold-standard method to diagnose NASH and hepatic fibrosis.…”