Prevalence of Elevated Alanine Aminotransferase Among US Adolescents and Associated Factors: NHANES 1999–2004

Fraser, Abigail; Longnecker, Matthew P.; Lawlor, Debbie A.

doi:10.1053/j.gastro.2007.08.077

Cited by 303 publications

(303 citation statements)

References 35 publications

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“…Among the entire pediatric population enrolled in this study, the prevalence of mild-serious NAFLD (score C 1) was 4.4%, with a prevalence of 6.6% in males and 2.0% in females. This result confirms the existence of a gender difference in the prevalence of NAFLD, which has also been shown in previous studies [2,9].…”

Section: Prevalence Of Pediatric Nafldsupporting

confidence: 92%

“…The global epidemic of childhood obesity has become a serious public health concern [1], and recent studies suggest that the prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing in children [2,3], especially in obese children [4,5]. This condition is considered to be the most common form of chronic liver disease in the pediatric population [6].…”

Section: Introductionmentioning

confidence: 99%

“…This condition is considered to be the most common form of chronic liver disease in the pediatric population [6]. Although the natural history of NAFLD has yet to be defined, it ranges from simple steatosis, which is a slowly progressing disorder, to steatohepatitis, fibrosis, and even to cirrhosis [2,3]. Rashid et al [7] reported cirrhosis in children as young as 10 years.…”

Section: Introductionmentioning

confidence: 99%

“…The aim of the study reported here was: (1) to determine whether each component of metabolic syndrome is positively correlated with the degree of NAFLD (doseresponse relationship); (2) to determine whether pediatric NAFLD is closely related to metabolic syndrome, insulin resistance, and waist circumference (WC).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of non-alcoholic fatty liver disease in children and relationship to metabolic syndrome, insulin resistance, and waist circumference

Tominaga

Fujimoto

Suzuki

et al. 2009

Environ Health Prev Med

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Objectives To investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) in children and its relationship to metabolic syndrome, insulin resistance, and waist circumference (WC). Methods This was a population-based cross-sectional, case-control study. Cases were selected among students of a primary and junior high school, respectively, and ageand sex-matched control subjects were selected randomly (ratio of cases to control subject was 37:113). Results Of the 846 students, aged between 6 and 15 years, enrolled in the study and screened by ultrasonography, 37 children were diagnosed as having NAFLD (score C 1). There was a significant sex difference in the prevalence of NAFLD(P = 0.003). The trend test revealed a strong doseresponse relationship (P \ 0.001) between pediatric NA-FLD and the number of the proposed components of pediatric metabolic syndrome in Japan (MetS-JC), such as a clustering of the components of MetS-JC. Additionally, the linear trend of the odds ratios (ORs) with increasing percentile of the homeostasis model assessmentinsulin resistance (HOMA-IR) was statistically significant (P \ 0.001). However, when WC was added to the logistic model, the ORs were no longer significant, whereas WC turned out to be an independent risk factor for NAFLD regardless of the HOMA-IR index. Conclusion The prevalence of NAFLD in children and adolescents is closely related to metabolic syndrome, insulin resistance, and WC.

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Section: Prevalence Of Pediatric Nafldsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence of non-alcoholic fatty liver disease in children and relationship to metabolic syndrome, insulin resistance, and waist circumference

Tominaga

Fujimoto

Suzuki

et al. 2009

Environ Health Prev Med

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“…26,[31][32][33][34][35] Conversely, Hispanics have a higher prevalence of NAFLD despite similar rates of MetS. 5,7,13,18,24,25 Given these intergroup differences, our goal was to assess relationships among MetS, IR, and NAFLD between racial/ ethnic groups. We evaluated adolescents from the NHANES for unexplained elevations in ALT as a potential marker for NAFLD.…”

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confidence: 99%

Ethnic Differences in the Link Between Insulin Resistance and Elevated ALT

DeBoer

Wiener²,

Barnes

et al. 2013

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Evaluating for elevations in alanine aminotransferase (ALT) is a common screening test for the presence of nonalcoholic fatty liver disease (NAFLD). NAFLD is less common among non-Hispanic blacks. Better predictors of NAFLD are needed to identify individuals in most need of screening. WHAT THIS STUDY ADDS:Relative to other ethnicities, metabolic syndrome and insulin resistance performed poorly at identifying non-Hispanic black adolescents with ALT elevations. The presence of metabolic syndrome may therefore not be an adequate trigger for NAFLD screening. Triglyceride elevations performed similarly between groups in identifying ALT elevations. abstract BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) exhibits tight links with insulin resistance (IR) and the metabolic syndrome (MetS), a cluster of cardiovascular risk factors. Compared with non-Hispanic whites, non-Hispanic black adolescents have more IR but a lower prevalence of NAFLD and MetS. Our hypothesis was that IR would be a better predictor of alanine aminotransferase (ALT) elevations than is MetS among non-Hispanic blacks. METHODS:We analyzed data from 4124 adolescents aged 12 to 19 years in the 1999 to 2010 NHANES, using unexplained elevations in ALT (.30 U/L) to characterize presumed NAFLD and using a pediatric adaptation of the Adult Treatment Panel III definition of MetS. RESULTS:Prevalence of elevated ALT varied by race/ethnicity (Hispanics 13.7%, non-Hispanic white 8.6%, non-Hispanic blacks 5.4%, P , .0001). Among non-Hispanic whites and Hispanics, a classification of MetS performed well in identifying adolescents with elevated ALT (odds ratios [ORs] 9.53 and 5.56, respectively), as did MetS-related indices. However, among non-Hispanic blacks, the association between MetS and ALT elevations was smaller in magnitude and technically nonsignificant (OR = 3.24, P = .051). Furthermore, among non-Hispanic blacks, the presence of IR and elevated waist circumference performed more poorly at identifying ALT elevations (ORs 3.93 and 2.28, respectively: significantly smaller than ORs for non-Hispanic whites, P , .05), with triglyceride elevations being a better predictor (OR = 4.44).CONCLUSIONS: Non-Hispanic black adolescents exhibit a lower relationship between IR and elevated ALT, supporting racial/ethnic differences in the link between MetS and NAFLD. These data may have implications regarding triggers for screening for NAFLD among nonHispanic black adolescents, focusing particularly on those with triglyceride elevations. Pediatrics 2013;132:e718-e726 KEY WORDS metabolic syndrome, visceral obesity, inflammation, racial/ethnic difference ABBREVIATIONS ALT-alanine aminotransferase BP-blood pressure GGT-g-glutamyl transferase HDL-C-high-density lipoprotein cholesterol HOMA-IR-homeostasis model of insulin resistance hsCRP-high-sensitivity C-reactive protein IR-insulin resistance MetS-metabolic syndrome NAFLD-nonalcoholic fatty liver disease OR-odds ratio WC-waist circumference Drs DeBoer, Wiener, and Barnes were involved in th...

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Intermittent Energy Restriction for Adolescents With Obesity

Lister,

Baur,

House

et al. 2024

JAMA Pediatr

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ImportanceAdolescent obesity requires effective and accessible treatment. Intensive dietary interventions have the potential to be used as adjunctive therapy for behavioral weight management.ObjectiveTo examine the effectiveness of 2 diet therapies, delivered as part of an intensive behavioral weight management intervention, in adolescents with metabolic complications associated with obesity.Design, Setting, and ParticipantsThis multisite, 52-week randomized clinical trial was conducted from January 31, 2018, to March 31, 2023, at 2 tertiary pediatric centers in Australia. Adolescents (aged 13-17 years) with obesity and 1 or more associated complications were included.InterventionsIntensive behavioral interventions, delivered by a multidisciplinary team, comparing intermittent energy restriction (IER) or continuous energy restriction (CER), with 3 phases: very low-energy diet (weeks 0-4), intensive intervention (weeks 5-16), and continued intervention and/or maintenance (weeks 17-52).Main Outcomes and MeasuresThe primary outcome was body mass index (BMI) z score at 52 weeks in the IER vs CER group. Anthropometry, body composition, and cardiometabolic health were assessed at baseline and 52 weeks. The BMI z score and percentiles were determined using Centers for Disease Control and Prevention growth charts. Insulin resistance, dyslipidemia, and elevated hepatic function were assessed.ResultsA total of 141 adolescents (median [IQR] age, 14.8 [12.9-17.9] years; 71 male [50.4%]) were enrolled, 71 in the IER group and 70 in the CER group, and 97 (68.8%) completed the intervention, 43 in the IER group and 54 in the CER group. At week 52, both groups had reduced BMI z scores (estimated marginal mean change, −0.28 [95% CI, −0.37 to −0.20] for IER and −0.28 [95% CI, −0.36 to −0.20] for CER) and reduced BMI expressed as a percentage of the 95th percentile (estimated marginal mean change, −9.56 [95% CI, −12.36 to −6.83] for IER and −9.23 [95% CI, −11.82 to −6.64] for CER). No differences were found in body composition or cardiometabolic outcomes between the groups. Both groups had a reduction in the occurrence of insulin resistance (from 52 of 68 [76.5%] to 32 of 56 [57.1%] in the IER group and from 59 of 68 [86.8%] to 31 of 60 [57.1%] in the CER group) at week 16; however, at week 52, this effect was observed in the CER group only (from 59 of 68 [86.7%] to 30 of 49 [61.2%]). The occurrence of dyslipidemia was unchanged between baseline and week 52 (60 of 137 [42.6%] and 37 of 87 [42.5%], respectively), with a small improvement in occurrence of impaired hepatic function tests (37 of 139 [27.0%] and 15 of 87 [17.2%], respectively). No differences were found in dyslipidemia or hepatic function between groups.Conclusions and RelevanceThese findings suggest that for adolescents with obesity-associated complications, IER can be incorporated into a behavioral weight management program, providing an option in addition to CER and offering participants more choice.Trial Registrationhttp://anzctr.org.au Identifier: ACTRN12617001630303

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Prevalence of Elevated Alanine Aminotransferase Among US Adolescents and Associated Factors: NHANES 1999–2004

Cited by 303 publications

References 35 publications

Prevalence of non-alcoholic fatty liver disease in children and relationship to metabolic syndrome, insulin resistance, and waist circumference

Prevalence of non-alcoholic fatty liver disease in children and relationship to metabolic syndrome, insulin resistance, and waist circumference

Ethnic Differences in the Link Between Insulin Resistance and Elevated ALT

Intermittent Energy Restriction for Adolescents With Obesity

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