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Abstract Details
Risk stratification of adolescents for the screening of non-alcoholic fatty liver disease
Pediatr Obes. 2022 May 2;e12924. doi: 10.1111/ijpo.12924. Online ahead of print.
1Prisma Health, Department of Medicine, Division of Gastroenterology and Liver Disease, University of South Carolina-SOM Greenville, Greenville, South Carolina, USA.
2Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, USA.
3Institute of Etiological Research, Boca Raton, Florida, USA.
4Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
5Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.
6Department of Integrated Medical Science, Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA.
Abstract
Background: Non-alcoholic fatty liver conditions in adolescence are associated with premature mortality in adulthood. Effective screening could impact the population burden of this disease.
Objectives: We sought to determine which adolescents should be screened for non-alcoholic fatty liver using vibration-controlled transient elastography.
Methods: We simulated a non-alcoholic fatty liver screening program of 938 adolescents from the National Health and Nutritional Examination Survey of 2017/2018. We stratified subjects by body mass index and metabolic parameters and analyzed our data using standard diagnostic statistical measures.
Results: The weighted prevalence of non-alcoholic fatty liver and non-alcoholic fatty liver disease was 24.4%, and 3.8%, respectively. For all subjects with obesity (21.8% of the population), screening identified 61.8% of the non-alcoholic fatty liver cases. In a category of all subjects with obesity and overweight subjects with metabolic abnormalities (26.7% of the population), screening identified 71.2% of non-alcoholic fatty liver cases.
Conclusions: The two groups most likely to benefit by transient elastography screening are adolescents with obesity and overweight adolescents with one metabolic abnormality. These criteria reduce the number of individuals to be tested by approximately 80% (from an approximate 32 million adolescents to 6-7.5 million adolescents), while retaining a diagnostic accuracy of 84%-85%.