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

doi:10.1111/ijpo.12862

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 journal › Article › peer-review

9 Scopus citations

Abstract

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 language	English
Article number	e12862
Journal	Pediatric obesity
Volume	17
Issue number	3
DOIs	https://doi.org/10.1111/ijpo.12862
State	Published - Mar 2022

Bibliographical note

Publisher Copyright:
© 2021 World Obesity Federation.

Funding

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).

Funders	Funder number
Department of Paediatrics	P30 GM127211
National Institutes of Health (NIH)	UL1TR0001198
National Center for Research Resources
National Center for Advancing Translational Sciences (NCATS)
University of Kentucky
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Keywords

ALT
NAFLD
diabetes
dyslipidaemia
obesity
paediatric

ASJC Scopus subject areas

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/ijpo.12862

Cite this

Radulescu, A., Dugan, A. J., Killian, M., Attia, S. L., Mouzaki, M., Fuchs, G. J., Kohli, R., Bada, H., Kern, P. A., & Softic, S. (2022). 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. Pediatric obesity, 17(3), Article e12862. https://doi.org/10.1111/ijpo.12862

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title = "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",

abstract = "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.",

keywords = "ALT, NAFLD, diabetes, dyslipidaemia, obesity, paediatric",

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

note = "Publisher Copyright: {\textcopyright} 2021 World Obesity Federation.",

year = "2022",

month = mar,

doi = "10.1111/ijpo.12862",

language = "English",

volume = "17",

number = "3",

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T1 - 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

AU - Radulescu, Aurelia

AU - Dugan, Adam J.

AU - Killian, Mary

AU - Attia, Suzanna L.

AU - Mouzaki, Marialena

AU - Fuchs, George J.

AU - Kohli, Rohit

AU - Bada, Henrietta

AU - Kern, Philip A.

AU - Softic, Samir

PY - 2022/3

Y1 - 2022/3

N2 - 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.

AB - 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.

KW - ALT

KW - NAFLD

KW - diabetes

KW - dyslipidaemia

KW - obesity

KW - paediatric

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M3 - Article

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AN - SCOPUS:85117185983

SN - 2047-6302

VL - 17

JO - Pediatric obesity

JF - Pediatric obesity

IS - 3

M1 - e12862

ER -

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

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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