Paediatric gastroenterology evaluation of overweight and obese children referred from primary care for suspected non-alcoholic fatty liver disease
Article first published online: 1 OCT 2013
© 2013 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Alimentary Pharmacology & Therapeutics
Volume 38, Issue 10, pages 1267–1277, November 2013
How to Cite
Schwimmer, J. B., Newton, K. P., Awai, H. I., Choi, L. J., Garcia, M. A., Ellis, L. L., Vanderwall, K. and Fontanesi, J. (2013), Paediatric gastroenterology evaluation of overweight and obese children referred from primary care for suspected non-alcoholic fatty liver disease. Alimentary Pharmacology & Therapeutics, 38: 1267–1277. doi: 10.1111/apt.12518
- Issue published online: 18 OCT 2013
- Article first published online: 1 OCT 2013
- Manuscript Revised: 13 SEP 2013
- Manuscript Accepted: 13 SEP 2013
- Manuscript Revised: 6 SEP 2013
- Manuscript Received: 3 SEP 2013
- NCRR . Grant Number: UL1RR031980
- UCSD. Grant Number: DK088925-02S1
- NSF. Grant Number: #414916
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.
To determine whether the detection of suspected NAFLD in overweight and obese children through screening in primary care and referral to paediatric 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 paediatric gastroenterology was captured prospectively. Diagnostic outcomes were reported. The diagnostic performance of two times the upper limit of normal (ULN) for alanine aminotransferase (ALT) was assessed.
Non-alcoholic fatty liver disease was diagnosed in 55% of children identified by screening and referral. 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 (P < 0.05) higher screening ALT (98 ± 95) than children with liver disease other than NAFLD (86 ± 74). Advanced fibrosis was present in 11% of children. For the diagnosis of NAFLD, screening ALT two times the clinical ULN had a sensitivity of 57% and a specificity of 71%.
Screening of overweight and obese children in primary care for NAFLD with referral to paediatric 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.