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Abstract Details
Variation in Alanine Aminotransferase in Children with Non-Alcoholic Fatty Liver Disease
Children (Basel). 2022 Mar 8;9(3):374. doi: 10.3390/children9030374.
1Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA 30322, USA.
2Department of Pediatrics, Morehouse School of Medicine, Atlanta, GA 30310, USA.
3Target RWE, Durham, NC 27703, USA.
4Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA.
5Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA.
6Pediatric Gastroenterology, Pediatric Transplant Hepatology, Miami Transplant Institute, Miami, FL 33136, USA.
7Division of Gastroenterology, OU Medicine, Oklahoma City, OK 73104, USA.
8Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH 44195, USA.
9The Children's Hospital at Montefiore, The Pediatric Hospital for Albert Einstein College of Medicine, Bronx, NY 10467, USA.
10Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA.
11Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA.
Abstract
Background: Pediatric non-alcoholic fatty liver disease (NAFLD) is a major public health concern. Aminotransferase (ALT) is frequently used for screening and monitoring, but few studies have reported typical patterns of ALT elevation in children.
Methods: TARGET-NASH is a real-world longitudinal observational cohort of patients with NAFLD receiving care across the United States. Analyses included children enrolled between 1 August 2016, and 12 October 2020, with at least one ALT measurement after enrollment. Peak ALT was based on the first and last available record and categorized into clinical cut points: <70 IU/L, >70-<250 IU/L, and >250 IU/L. A chi-squared test was used to compare differences in proportions, and a Kruskal-Wallis test was used to compare the medians and distributions of continuous responses.
Results: Analyses included 660 children with a median age of 13 years. Of the 660, a total of 187 had undergone a biopsy and were more likely to be Hispanic or Latino (67% vs. 57%, p = 0.02) and to have cirrhosis (10% vs. 1%, p < 0.001). The highest ALT scores ranged from 28 U/L to 929 U/L; however, these scores varied across time. The prevalence of cirrhosis or any liver fibrosis stage was most common among children with a peak ALT > 70 U/L.
Conclusions: Large variability was seen in ALT among children, including many values > 250 U/L. Higher levels of ALT were associated with increased prevalence of comorbidities and more advanced stages of NAFLD. These findings support an increased need for therapeutics and disease severity assessment in children with peak ALT > 70 U/L.