Stratification by obesity class, rather than age, can identify a higher percent of children at risk for non-alcoholic fatty liver disease and metabolic dysfunction

Aurelia Radulescu, Adam J. Dugan, Mary Killian, Suzanna L. Attia, Marialena Mouzaki, George J. Fuchs, Rohit Kohli, Henrietta Bada, Philip A. Kern, Samir Softic

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: An increasing number of clinical practice guidelines recommend screening children with obesity for non-alcoholic fatty liver disease (NAFLD). However, there is limited evidence regarding what parameters should be used to initiate the screening. Objective: The objective of this study was to determine whether obesity class rather than age group can identify a higher percent of children at risk of NAFLD as assessed by abnormal alanine aminotransferase (ALT). Methods: This is a cross-sectional study in a regional referral clinic for evaluation of obesity. Children were stratified by age group or by obesity class, and data obtained at first visit were analysed. Results: Of the 784 children, 482 were ≥10, 209 were 6 to 9 and 93 were 2 to 5 years of age. Abnormal ALT was observed in 32.1%, 46.9% and 61.0% of children with class I, II or III obesity, respectively (p < 0.001), while the risk of abnormal ALT did not differ in very young (2–5), young (6–9), or children older than 10 years. A multivariable analysis showed that class II and class III obesity were associated with 2.1-fold (1.27-3.72) and 4-fold (2.41-6.96) greater odds of abnormal ALT compared with class I obesity. African-American children had lower risk of abnormal ALT (0.27), whereas Hispanic children had higher risk (2.37). Obesity class was a better predictor of abnormal ALT than age, especially in girls. Furthermore, 66.7% of boys (p = 0.009) and 69% of girls (p < 0.001) with abnormal ALT exhibited additional signs of metabolic dysfunction. Conclusion: Obesity class is more strongly associated with abnormal ALT than age.

Original languageEnglish
Article numbere12862
JournalPediatric obesity
Issue number3
StatePublished - Mar 2022

Bibliographical note

Funding Information:
AR and SS contributed to conceptualization, methodology, investigating and wrote the manuscript. AJD preformed data curation and analysis. MK contributed to investigation and data curation. All authors helped with the investigation, writing the manuscript and had final approval of the submitted and published versions. We would like to thank Jungjun Bae and Christian Eisinger from the Institute for Pharmaceutical Outcomes & Policy, at University of Kentucky (UKY) College of Pharmacy for mapping assistance. SS was supported by the Department of Paediatrics at UKY and the Department of Pharmacology and Nutritional Sciences startup funds, as well as by P30 GM127211 and NASPGHAN Foundation Young Investigator Award. MK was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, Grant UL1TR0001198 and the Professional Student Medical Research Fellowship (PSMRF).

Publisher Copyright:
© 2021 World Obesity Federation.


  • ALT
  • diabetes
  • dyslipidaemia
  • obesity
  • paediatric

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Health Policy
  • Nutrition and Dietetics
  • Public Health, Environmental and Occupational Health


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