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Gastroenterology evaluation of overweight and obese children with suspected NAFLD

A study in the most recent issue of Alimentary Pharmacology & Therapeutics investigates the pediatric gastroenterology evaluation of overweight and obese children referred from primary care for suspected non-alcoholic fatty liver disease.

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Screening overweight and obese children for non-alcoholic fatty liver disease (NAFLD) is recommended by paediatric and endocrinology societies.

However, gastroenterology societies have called for more data before making a formal recommendation.

Dr Schwimmer and colleagues from California, USA determined whether the detection of suspected NAFLD in overweight and obese children through screening in primary care and referral to pediatric gastroenterology resulted in a correct diagnosis of NAFLD.

Information generated in the clinical evaluation of 347 children identified with suspected NAFLD through screening in primary care and referral to pediatric gastroenterology was captured prospectively.

Diagnostic outcomes were reported.

NAFLD was found in 55% of children identified by screening
Alimentary Pharmacology & Therapeutics

The diagnostic performance of 2 times the upper limit of normal (ULN) for alanine aminotransferase (ALT) was assessed.

The researchers diagnosed non-alcoholic fatty liver disease in 55% of children identified by screening and referral.

The team noted that liver disease other than NAFLD was present in 18% of those referred.

Autoimmune hepatitis was the most common alternative diagnosis.

Children with NAFLD had significantly higher screening ALT than children with liver disease other than NAFLD.

The team observed that advanced fibrosis was present in 11% of children.

For the diagnosis of NAFLD, the researchers found that screening ALT 2 times the clinical ULN had a sensitivity of 57%, and a specificity of 71%.

Dr Schwimmer's team concludes, "Screening of overweight and obese children in primary care for NAFLD with referral to pediatric gastroenterology has the potential to identify clinically relevant liver pathology."

"Consensus is needed on how to value the risk and rewards of screening and referral, to identify children with liver disease in the most appropriate manner."

Aliment Pharmacol Ther 2013: 38(10): 1267–1277
04 November 2013

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