Revision of serum ALT upper limits of normal facilitates assessment of mild liver injury in obese children with non‐alcoholic fatty liver disease

Abstract

Background The serum alanine aminotransferase (ALT) level is a critical parameter for evaluating liver injury in non‐alcoholic fatty liver disease (NAFLD). However, the currently accepted upper limits of normal (ULN) for serum ALT (ULN‐ALT) are debated, as they may be excessively high. Methods A total of 1638 children aged 6‐16 years, comprising 507 children with normal BMI (500 healthy children and 7 children with NAFLD), 199 overweight children, and 932 obese children, were included in the analysis. We re‐evaluated the ULN‐ALT in 500 healthy Chinese children using the 95th percentiles of serum ALT levels as revised ULN‐ALT. Fatty liver was identified by ultrasound examination. Results Significant positive correlations between serum ALT levels and body mass index (BMI) were detected in overweight boys ( r = .399, P < .001), obese boys ( r = .398, P < .001), and obese girls ( r = .392, P < .001). The prevalence percentages of NAFLD were 93.6%, 75.8%, and 37.9% in obese boys with serum ALT levels of >50, 25‐50, and ≤25 U/L and were 81.6%, 67.9%, and 20.6% in obese girls with serum ALT levels of >40, 20‐40, and ≤20 U/L, respectively. Conclusion Serum ALT levels significantly correlated with abnormal BMI values in children, suggesting a rigorous BMI threshold is needed to establish the cutoffs for serum ULN‐ALT in children. Besides, the revised serum ULN‐ALT can uncover mild liver injury in obese children with NAFLD.

The different effects of psyllium husk and orlistat on weight control, the amelioration of hypercholesterolemia and non-alcohol fatty liver disease in obese mice induced by a high-fat diet

“…34 ALT is an indicator of hepatocyte injury. 35 Compared to the NC group, serum ALT levels increased significantly in the MC group ( P < 0.001, Fig. 5a), suggesting hepatocyte damage in the MC group due to lipid toxicity.…”

The burden and sexual dimorphism with nonalcoholic fatty liver disease in Asian children: A systematic review and meta‐analysis

“…The search identified 735 references and 127 papers were selected for full‐text review. Finally, 31 articles 14‐44 describing 33 study populations fulfilled the criteria and included in the systematic review and pooled analysis (Figure 1). All the articles were published after 2004, and before April 28, 2021.…”

“…The features of the 31 studies 14‐44 were provided in Table 1. Eighteen studies in Eastern Asia (15 from China, two from Japan, one from Korea), 11 studies in Western Asia (five from Iran, five from Turkey, one from Israel) and two studies in Southern Asia (two from India).…”

Transient Elastography in the Diagnosis of Pediatric Non-alcoholic Fatty Liver Disease and Its Subtypes

“…However, increased scholars at home and abroad have suggested that children's ALT threshold in screening NAFLD should be lower than adults'. Lu et al ( 11 ) revised the serum ULN-ALT (25 U/L for males and 20 U/L for females), showing that the prevalence of NASH in children in China may be underestimated. NASH is a subtype of NAFLD that can develop into cirrhosis, hepatocellular carcinoma, and even death ( 12 ), and children usually suffer more severe NAFLD than adults ( 13 ), among all about 15%were accompanied with NASH and associated cirrhosis when diagnosed with NAFLD ( 14 , 15 ).…”