Influence of Gender, Race, and Ethnicity on Suspected Fatty Liver in Obese Adolescents

Abstract

ABSTRACT. Objectives. Fatty liver is a common cause of liver disease in children. However, the epidemiology of pediatric fatty liver is limited to single-center case series of nonalcoholic fatty liver disease (NAFLD). Obesity and insulin resistance are major established risk factors for NAFLD. The role of gender, race, and ethnicity on the prevalence of fatty liver in obese children is unknown.Methods. We recruited obese 12th-grade participants from the Child and Adolescent Trial for Cardiovascular Health in California, Louisiana, Minnesota, and Texas. Serum samples were collected at school when the participants were well. Alanine aminotransferase (ALT) was measured by kinetic enzymatic assay, and ALT >40 U/L was defined as abnormal. Causes of abnormal ALT other than NAFLD were excluded by serum testing.Results. A total of 127 obese students (73 female, 54 male) had a mean BMI of 35.2 kg/m 2 . Unexplained ALT elevation was present in 23% of participants overall. The mean ALT for participants with normal values was 28 U/L and for participants with an abnormal ALT was 56 U/L. Abnormal ALT was significantly more prevalent in boys (44%) than in girls (7%). The prevalence of abnormal ALT differed significantly by race and ethnicity (Hispanic: 36%; white: 22%; black: 14%). Serum ALT value was significantly predicted by the combination of gender, race/ethnicity, and BMI. After controlling for gender and BMI, Hispanic ethnicity significantly predicted greater ALT than black race.Conclusions. In a national, school-based sample of obese adolescents, boys were 6 times more likely than girls to have an unexplained elevated ALT. Given that participants were well and causes of chronic liver disease were excluded, we speculate that obese adolescent boys have an increased prevalence of fatty liver compared with obese adolescent girls. This population-based study also supports the hypothesis that NAFLD is more common in Hispanic adolescents. These findings have implications for both disease screening and studies of fatty liver pathophysiology. N onalcoholic fatty liver disease (NAFLD) is regarded as the most common cause of liver disease in children. 1 NAFLD encompasses a range of liver histology severity and outcomes in the absence of chronic alcohol use. The most mild form is simple steatosis in which triglyceride accumulates within hepatocytes. A more advanced form of NAFLD, nonalcoholic steatohepatitis (NASH), includes inflammation and liver cell injury. NASH was first described in children in 1983, 2 and more recently, several investigators have reported that NASH may present with cirrhosis and end-stage liver disease in some children. [3][4][5][6] Established risk factors for NAFLD in children include obesity, insulin resistance, and type 2 diabetes. 5,7,8 Although most pediatric patients with NAFLD are obese, only a subset of obese children or adolescents will develop NAFLD. Gender is likely to be 1 important factor that modifies the risk for NAFLD. Early studies in adults suggested that women were more likely than men to...

Nonalcoholic fatty liver disease: a challenge for pediatricians

“…[19][20][21][22][23] Population-based approaches by this method, suggests an overall prevalence of at least 3% for suspected fatty liver disease among children and adolescents in the United States and Asia. 9,17 The histology of the liver, the most important criterion for diagnosis is usually not being used for screening. Data from autopsy records shows the prevalence of NASH about 6.27% in adults.…”

“…25 NASH had case histories published from North America, Europe, Australia and Asia. 9,13,16,18 About two-thirds of obese adults and half of obese children may have fatty liver. 17,19,21 When compared with their normal counterparts, overweight and obese adolescents had 4.14 and 5.98 times the risk of having NAFLD.…”

“…10 After controlling for gender, race, and ethnicity, its prevalence increased with age ranging from 0.7% for ages 2-4 years up to 17.3% for ages of 15-19. 8,19 The pediatric fatty liver disease has shown a male predominance on the basis of pathology 9,26 and higher abnormal alanine transaminase (ALT) (males: females, 44-7%). 9 Biopsy-proven NAFLD has a ratio of 2.2:1 in boys to girls on the basis of linking of clinical cases from four different continents.…”

The management of childhood liver diseases in adulthood

“…In parallel to this rising epidemic of obesity, non-alcoholic fatty liver disease (NAFLD) is now the most common cause of chronic liver disease in both children and adults. Male children appear to be more affected than their female counterparts [115,116]. The histological findings in children and adults are different and are summarised in Fig.…”

“…Review young adults [114,115]. In parallel to this rising epidemic of obesity, non-alcoholic fatty liver disease (NAFLD) is now the most common cause of chronic liver disease in both children and adults.…”