Comparison between non-alcoholic fatty liver disease screening guidelines in children and adolescents

Ezaizi, Yamen; Kabbany, Mohammad Nasser; Selvakumar, Praveen Kumar Conjeevaram; Sarmini, Muhammed Talal; Singh, Amandeep; López, Rocío; Nobili, Valério; Alkhouri, Naim

doi:10.1016/j.jhepr.2019.06.005

Cited by 28 publications

(30 citation statements)

References 19 publications

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“…However, in a very recent study, two screening strategies were compared: the NASPGHAN strategy using an ALT cut-off of >2x the gender-specific upper limit of normal and the ESPGHAN strategy using elevated ALT >45 IU/L and/or fatty liver on ultrasound. The study showed that by relying on ALT values alone to screen for NAFLD, suspected NAFLD might be missed in many children who are at risk to develop the disease (49). In our study, it is possible that some subjects with US-diagnosis of NAFLD (due to low sensitivity) were enrolled in the control groups.…”

Section: Discussionmentioning

confidence: 95%

Nonalcoholic Fatty Liver Disease Is Associated With Low Skeletal Muscle Mass in Overweight/Obese Youths

et al. 2020

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Background: Recent studies in adult non-elderly and elderly individuals have reported a link between nonalcoholic fatty liver disease (NAFLD) and sarcopenia. Nonetheless, whether this relationship would be found outside these populations it is still unknown. Hence, we evaluated the relationship between NAFLD and skeletal muscle mass in children and adolescents with overweight/obesity. Methods: Two-hundred and thirty-four overweight/obese youths were enrolled. NAFLD was diagnosed by ultrasononography, after exclusion of infectious and metabolic disorders. Forty of the patients with NAFLD had also liver biopsy. Total and regional lean body mass and total fat mass measurements were obtained by dual-energy X-ray absorptiometry. The relative muscle mass (RMM) was defined as the percent of muscle mass (kg) relative to the sum of muscle and fat (kg) mass. Appendicular skeletal muscle mass (ASM) was calculated by the sum of muscle masses of the four limbs (kg), and expressed as percent of body weight. Results: Subjects were stratified according to tertiles of RMM. The prevalence of abdominal obesity, dyslipidemia, insulin resistance, metabolic syndrome, NAFLD as well as biopsy-proven nonalcoholic steatohepatitis (NASH) was significantly increased in the lowest tertile of RMM. After controlling for age, sex and Tanner stage, children in the lowest tertile of RMM had an increased risk for NAFLD (OR= 2.80, 95% CI=1.57-5.02) compared to those in the other two tertiles. This association persisted after additional adjustments for clinical and metabolic variables. Similarly, the risk of NAFLD in the lowest tertile of ASM/weight index was significantly higher compared to those in the other two tertiles after adjustment for the above confounders. Conclusions: This is the first study to establish an independent association between low muscle mass and NAFLD/NASH in overweight/obese youths. Considering the worldwide increase of pediatric obesity, measurements of muscle mass may serve as useful method of identifying among obese children those at high metabolic risk who may need intensive lifestyle interventions to prevent NAFLD and its progression.

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Section: Discussionmentioning

confidence: 95%

Nonalcoholic Fatty Liver Disease Is Associated With Low Skeletal Muscle Mass in Overweight/Obese Youths

et al. 2020

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“…The European Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) suggested that all overweight and obese children above 3 years old should be screened for NAFLD by performing abdominal ultrasound and liver function tests. Ezaizi et al suggested using a combination of elevated ALT and fatty infiltration on ultrasound to increase the detection rate and to avoid missed detection of suspected NAFLD children at risk ( 81 ). Ultrasonography is a safe and reliable tool for the diagnosis of NAFLD.…”

Section: Pediatric Non-alcoholic Fatty Liver Disease (Nafld)mentioning

confidence: 99%

Possible Hepatoprotective Effect of Tocotrienol-Rich Fraction Vitamin E in Non-alcoholic Fatty Liver Disease in Obese Children and Adolescents

et al. 2021

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Obesity has become a worldwide health concern among the pediatric population. The prevalence of non-alcoholic fatty liver disease (NAFLD) is growing rapidly, alongside the high prevalence of obesity. NAFLD refers to a multifactorial disorder that includes simple steatosis to non-alcoholic steatohepatitis (NASH) with or devoid of fibrosis. NAFLD is regarded as a systemic disorder that influences glucose, lipid, and energy metabolism with hepatic manifestations. A sedentary lifestyle and poor choice of food remain the major contributors to the disease. Prompt and timely diagnosis of NAFLD among overweight children is crucial to prevent the progression of the condition. Yet, there has been no approved pharmacological treatment for NAFLD in adults or children. As indicated by clinical evidence, lifestyle modification plays a vital role as a primary form of therapy for managing and treating NAFLD. Emphasis is on the significance of caloric restriction, particularly macronutrients (fats, carbohydrates, and proteins) in altering the disease consequences. A growing number of studies are now focusing on establishing a link between vitamins and NAFLD. Different types of vitamin supplements have been shown to be effective in treating NAFLD. In this review, we elaborate on the potential role of vitamin E with a high content of tocotrienol as a therapeutic alternative in treating NAFLD in obese children.

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“…Eligible studies were RCTs written in English assessing the effects of diet or physical activity on children with NAFLD, aged below or equal to 18-years old. As NAFLD diagnosis might be missed in children when relying only on alanine aminotransferase (ALT) [23], the present systematic review strictly evaluated RCTs in which NAFLD diagnosis was based either on imaging or biopsy. Imaging included ultrasound (US) or proton magnetic resonance spectroscopy ( 1 H-MRS) or magnetic resonance imaging (MRI) of the liver.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Effects of Dietary and Lifestyle Interventions on Liver, Clinical and Metabolic Parameters in Children and Adolescents with Non-Alcoholic Fatty Liver Disease: A Systematic Review

et al. 2020

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Non-alcoholic fatty liver disease (NAFLD) affects 5.5–10.3% of children worldwide, while in obese individuals, it increases to almost 34%. Pediatric NAFLD is consistently associated with metabolic syndrome and insulin resistance. As no pharmacological agents exist for the treatment of NAFLD, lifestyle modifications remain the only therapy. However, as not all overweight/obese children have NAFLD, high-quality data, focused exclusively on NAFLD population are needed. Therefore, the present systematic review assessed the efficacy of lifestyle (diet or exercise) based on randomized controlled clinical trials (RCTs) on liver, anthropometric, glucose, and lipid parameters in children, with imaging or biopsy-proven NAFLD. In general, the results were inconclusive and therefore no specific recommendations could be drawn. In most studies, differences were derived from within group comparisons, which are known to be highly misleading. However, both low-carbohydrate and low-fat diets could benefit liver outcomes, as long as weight loss is achieved, but not necessary glucose and lipid parameters. No RCTs were found on exercise alone, as compared to no intervention on pediatric NAFLD. Concerning diet plus exercise interventions, all studies led to improvements in liver outcomes accompanied with weight loss. Resolution of NAFLD was found in considerably high percentages, while improvements were also seen in glucose but were modest in lipid parameters.

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Comparison between non-alcoholic fatty liver disease screening guidelines in children and adolescents

Cited by 28 publications

References 19 publications

Nonalcoholic Fatty Liver Disease Is Associated With Low Skeletal Muscle Mass in Overweight/Obese Youths

Nonalcoholic Fatty Liver Disease Is Associated With Low Skeletal Muscle Mass in Overweight/Obese Youths

Possible Hepatoprotective Effect of Tocotrienol-Rich Fraction Vitamin E in Non-alcoholic Fatty Liver Disease in Obese Children and Adolescents

Effects of Dietary and Lifestyle Interventions on Liver, Clinical and Metabolic Parameters in Children and Adolescents with Non-Alcoholic Fatty Liver Disease: A Systematic Review

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