Major Finding: Nonalcoholic fatty liver disease in obese children, adolescents, and young adults was twice as high among males as females, with 27% vs. 13% having ALT levels above 40 IU/L. The NAFLD prevalence increased with age in males but decreased with age in females.
Data Source: A prospective, cross-sectional study of 156 obese youth aged 5-20 years.
Disclosures: Dr. Gupta stated that he had no conflicts of interest.
BOSTON — Nonalcoholic fatty liver disease was found in 19% of 156 obese children and young adults aged 5-20 years in a cross-sectional analysis.
In the study, more than half of the males aged 16-20 years had NAFLD, reported Dr. Rish Gupta at the meeting.
The findings suggest that liver function testing (LFT) should be considered in obese children with dyslipidemia and/or insulin resistance, said Dr. Gupta, a pediatric endocrinology fellow at the State University of New York Downstate Medical Center, Brooklyn.
The multiethnic group of 86 females and 70 males all had BMIs greater than the 95th percentile, but did not have diabetes, abnormal thyroid function, or liver disease due to hepatitis or Wilson's disease. Thirty (19%) had levels of ALT greater than 40 IU/L, generally considered the cutoff to indicate NAFLD.
The subjects with elevated ALT did not differ from those with ALT levels at or below 40 IU/L in age (average, 12 years) or BMI (34 kg/m
The prevalence of NAFLD was twice as high in the males as the females, with 27% vs. 13% having ALT levels above 40 IU/L. Males with NAFLD had significantly higher triglycerides than did the females with NAFLD (231 vs. 193 mg/dL), and also had lower HDL (34 vs. 35 mg/dL).
The prevalence of NAFLD rose with age for the entire study group, from 14.5% for 5- to 10-year-olds to 18% for 11- to 15-year-olds, to 31% for 16- to 20-year-olds. However, when broken down by sex, the relation between NAFLD and age went in opposite directions. It actually dropped with age in the females, from 15.1% in the youngest group to 14.7% in the 11- to 15-year group to 7.1% in the older teens/young adults. In contrast, in the males the NAFLD prevalence rose with age from 13.6% to 24.2% to 53%.
The reason for the sex difference in the direction of NAFLD with age may be that puberty in boys is associated with increased insulin resistance, whereas high estrogen levels in females may be protective against NAFLD, Dr. Gupta said.
In an interview, Dr. Gupta advised that all children with a BMI of more than the 95th percentile or with insulin resistance or hypercholesterolemia should undergo LFT. If elevated, the LFT should be repeated in the next 3-6 months. Children with persistently elevated ALT should be further evaluated for viral markers to rule out other known causes of liver disorders.
In addition to lifestyle modification to promote weight loss and improved insulin sensitivity, metformin also can be used to treat NAFLD in children, he said.
Males with NAFLD had higher triglycerides than did the females with NAFLD, and also had lower HDL.
Source DR. GUPTA