Screening for elevated risk of liver disease in preschool children (aged 2–5 years) being seen for obesity management

Abstract

Objectives:Elevated alanine aminotransferase can heighten concern for the presence of nonalcoholic fatty liver disease in obese children. Guidelines recommend alanine aminotransferase screening of obese children start at the age of 10 years. We examined alanine aminotransferase values routinely obtained for tertiary obesity care among preschool (2–5 years) and school-age children.Methods:Medical records of children attending a tertiary obesity clinic and with alanine aminotransferase measured within 6 months of the initial visit were reviewed. Children with known genetic abnormalities were excluded. Children were grouped by age to focus attention on groups not covered by screening guidelines. Associations with elevated alanine aminotransferase (>30 IU/L) were examined.Results:A total of 284 records were analyzed (73 preschool, 143 young school-age (6–9 years), 68 older school-age (10–11 years)). Children were primarily Hispanic and had body mass index ≥ 99th percentile (preschool children 92%, young school-age 73%, older school-age 59%). In all, 26% of preschool children had elevated alanine aminotransferase (young school-age 30%, older school-age 44%). Preschool children with elevated alanine aminotransferase had higher body mass index compared to preschool children with alanine aminotransferase ≤ 30 IU/L (median body mass index 27.8 kg/m2 vs 24.0 kg/m2; Mann–Whitney U test, p = 0.003), but there was no disparity for elevated alanine aminotransferase related to Hispanic ethnicity. For older children, Hispanic ethnicity, not body mass index, predicted elevated alanine aminotransferase.Conclusion:Alanine aminotransferase elevation was common in these preschool children. Screening severely obese children for elevated alanine aminotransferase should begin at the age of 2 years.

Epidemiology of Pediatric Nonalcoholic Fatty Liver Disease

“…It is unknown whether this trend reflects greater screening for disease in younger children or a true increase in the underlying rate of NAFLD in young children. This is evident in a 2014 study in young children where 26% of preschool children aged 2 to 5 years with obesity had elevated alanine aminotransferase (ALT) level 9 . In addition, in a study in Hispanic children aged 4 to 5 years with obesity, 15% had elevated ALT level 10 …”

The role of NAFLD in cardiometabolic disease: an update

“…Some evidence for NAFLD in preschool-aged children within high risk groups also exists. In a study mostly of Hispanic children in an obesity clinic, about one fourth of children starting at preschool age had elevated alanine aminotransferase (ALT) for age, and this proportion rose to nearly half by middle-school age 38 .…”

The Progression and Natural History of Pediatric Nonalcoholic Fatty Liver Disease

“…As opposed to a general population based study, there may be unique populations of young children with higher rates of NAFLD. In a study of obese preschool age children in Chicago, elevated alanine aminotransferase (ALT) was reported in 26% of obese children aged 2–5 years [6]. In a study of Hispanic children in Houston with a majority of the children being obese, ALT > 35 U/L was reported in 15% of 4–5 year olds [7].…”