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Age- and Ethnic-Specific Elevation of ALT Among Obese Children at Risk for Nonalcoholic Steatohepatitis (NASH): Implications for Screening

Children's Hospital of Philadelphia, Pennsylvania, leungd{at}email.chop.edu

Kent Williams, MD

Vanderbilt University School of Medicine, Nashville, Tennessee

J. Kennard Fraley, MS, BS

Baylor College of Medicine, Texas Children's Hospital, Houston, Texas

William J. Klish, MD

Baylor College of Medicine, Texas Children's Hospital, Houston, Texas

The objectives are to: (1) characterize ethnic-specific differences in alanine aminotransferase (ALT) elevation among obese children, (2) investigate the earliest ages at which significant ALT elevation occurs, and (3) determine associations between ALT and biochemical parameters. A cohort of 134 multiethnic obese children and adolescents was analyzed retrospectively. ALT levels 45 U/L or <45 U/L, denoting high or normal risk, were used to categorize obese children's risk for developing nonalcoholic steatohepatitis. In all, 60% of Hispanics had high-risk ALT levels compared with 12% of whites and 8% of blacks. A significantly higher proportion of boys had ALT 45 U/L (49.4%, vs 37.9% for girls, P = .002); 17.5% were Hispanic boys less than 7 years old. Obese Hispanic children, particularly boys, not only have higher ALT levels but present alarmingly young with high-risk levels. This study highlights a discrete subgroup of children who may present with fatty liver at a younger age and should be screened earlier.

Key Words: Hispanic • NASH • pediatric • age • ALT • obesity • screening

This version was published on January 1, 2009

Clinical Pediatrics, Vol. 48, No. 1, 50-57 (2009)
DOI: 10.1177/0009922808321678


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