Evaluating the Diagnostic Criteria for NAFLD

Purpose: Nonalcoholic Fatty Liver Disease (NAFLD) is the most prevalent chronic liver disease in American children and adolescents, thought to involve hepatic fat deposition and inflammatory changes secondary to insulin resistance. Methods: Diagnosis is currently based on elevated ALT levels and subsequent liver ultrasound. Ultrasound, however, has proven to be less accurate in pediatrics than adults. Due to these limitations of utilizing ultrasound, liver biopsy remains the gold-standard of NAFLD diagnosis on children. Although biopsy is the most definitive diagnostic method, non-invasive biomarkers need to be further investigated for their diagnostic value to children. A retrospective chart review was completed to describe the clinical parameters of patients with NAFLD. Results: 45 patients (56% male) had a primary diagnosis relating to NAFLD; mean age 9.8 years (range 0‒18 years). Mean BMI percentile was 84% (90% males; 79% females). Median ALT 79; 82.5 males; 79 females; range 25‒1823 (ref 7‒55 U/L males; 7‒45 U/L females). Median AST 59; 60 males; 55 females; range 18‒2353 (ref 8‒60 U/L males 1‒13 years; 8‒50 females 1‒13 years). These results allow us to study the profile of patients evaluated for NAFLD at Cook Children’s. Conclusions: A better understanding of the criteria used by physicians can potentially help with early identification, prevention of disease progression, and improve care of children with NAFLD.