Alternative Etiologies of Liver Disease in Children With Suspected NAFLD

Toshifumi Yodoshi; Sarah Orkin; Ana Catalina Arce-Clachar; Kristin Bramlage; Stavra A Xanthakos; Pamela L Valentino; Marialena Mouzaki

doi:10.1542/peds.2020-009829

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Alternative Etiologies of Liver Disease in Children With Suspected NAFLD

Journal article

Open access

Peer reviewed

Alternative Etiologies of Liver Disease in Children With Suspected NAFLD

Toshifumi Yodoshi, Sarah Orkin, Ana Catalina Arce-Clachar, Kristin Bramlage, Stavra A Xanthakos, Pamela L Valentino and Marialena Mouzaki

Pediatrics (Evanston), Vol.147(4), pp.88-88

04/2021

DOI: 10.1542/peds.2020-009829

PMID: 33785637

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Abstract

To determine the prevalence of alternative causes of liver disease in a cohort of youth with overweight and obesity undergoing evaluation for suspected nonalcoholic fatty liver disease (NAFLD). Multicenter, retrospective cohort study of patients aged ≤18 years with overweight and obesity and evidence of elevated serum aminotransferases and/or hepatic steatosis on imaging, referred for suspected NAFLD to Cincinnati Children's Hospital Medical Center (2009-2017) or Yale New Haven Children's Hospital (2012-2017). Testing was performed to exclude the following: autoimmune hepatitis (AIH), Wilson disease, viral hepatitis (B and C), thyroid dysfunction, celiac disease, α-1 antitrypsin deficiency, and hemochromatosis. A total of 900 children with overweight and obesity (63% boys, 26% Hispanic ethnicity) were referred, with a median age of 13 years (range: 2-18). Most had severe obesity ( = 666; 76%) with a median BMI score of 2.45 (interquartile range [IQR]: 2.2-2.7). Median alanine aminotransferase level at presentation was 64 U/L (IQR: 42-95). A clinically indicated liver biopsy was performed in 358 children (40%) at a median of 6 months (IQR: 1-14) post initial visit; of those, 46% had confirmed nonalcoholic steatohepatitis. Positive autoantibodies were observed in 13% of the cohort, but none met criteria for AIH. Only 19 (2%) were found to have other causes of liver disease, with no cases of viral hepatitis or Wilson disease detected. In a large, multicenter cohort, the vast majority of children with overweight and obesity with presumed or confirmed NAFLD tested negative for other causes of liver disease. In contrast to a previous pediatric report, no patient was diagnosed with AIH.

Adolescent

Alanine Transaminase - blood

Autoantibodies - blood

Child

Child, Preschool

Cohort Studies

Female

Humans

Male

Non-alcoholic Fatty Liver Disease - diagnosis

Overweight - epidemiology

Pediatric Obesity - epidemiology

Retrospective Studies

Details

Title: Subtitle: Alternative Etiologies of Liver Disease in Children With Suspected NAFLD
Creators: Toshifumi Yodoshi - Cincinnati Children's Hospital Medical Center
Sarah Orkin - Cincinnati Children's Hospital Medical Center
Ana Catalina Arce-Clachar - Cincinnati Children's Hospital Medical Center
Kristin Bramlage - Cincinnati Children's Hospital Medical Center
Stavra A Xanthakos - Cincinnati Children's Hospital Medical Center
Pamela L Valentino - Yale University
Marialena Mouzaki - Cincinnati Children's Hospital Medical Center
Resource Type: Journal article
Publication Details: Pediatrics (Evanston), Vol.147(4), pp.88-88
DOI: 10.1542/peds.2020-009829
PMID: 33785637
NLM abbreviation: Pediatrics
ISSN: 0031-4005
eISSN: 1098-4275
Grant note: T32 DK007727 / NIDDK NIH HHS UL1 TR001863 / NCATS NIH HHS
Language: English
Date published: 04/2021
Academic Unit: Stead Family Department of Pediatrics; Gastroenterology, Hepatology, Pancreatology, and Nutrition
Record Identifier: 9985214101502771

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