Prevalence and Correlation of Non Alcoholic Fatty Liver Disease (NAFLD) with Serum Alanine Aminotransferase (ALT) Levels in Obese Indian Children

Archana Arya; Hriday De; Vasundhara Chugh

Aims: Non-alcoholic fatty liver disease (NAFLD) is the asymptomatic involvement of liver due to fatty infiltration of hepatocytes seen commonly in obese children. Elevated serum aminotransferase level serves as a surrogate marker of NAFLD. The recommended ALT cut-offs for screening for NAFLD in obese boys and girls are 22 and 25U/L respectively. We determined the prevalence of NAFLD amongst obese children in our population based on Liver Ultrasonography(USG), and determined the correlation of NAFLD with ALT levels and dyslipidemia in these children.

Methods: In this retrospective study, data from 223 obese children aged 1-18 years, with no other liver or chronic disease was analyzed. Body mass index, ALT, Fasting lipid profile, blood glucose and HbA1C were measured in all the subjects. NAFLD was diagnosed by ultrasonography. Presence of dyslipidemia was identified by any abnormality in the lipid profile as given below.


	Abnormal, mg/dl
Total cholesterol	≥200
LDL Cholesterol	≥130
Triglycerides <10y 10-19y	≥100 ≥130
HDL Cholesterol	<40

Abnormal values represent the 95^th percentile, HDL cholesterol represents the 10^th percentile.

Result: We found a very high prevalence of NAFLD (40.8%) in our obese population based on USG. 71.4% children with NAFLD had associated dyslipidemia. We also found a very high prevalence of NAFLD in the group with ALT<22 in girls (33%) and ALT<25 in boys (25%).

Percentage of children with NAFLD in relation to ALT levels and it's correlation with dyslipidemia.

Girls


ALT (U/L)	≤22	>22-40	> 40	Overall
NAFLD (USG)	33.33% (15/45)	34.14% (14/41)	55.5% (20/36)	40.16% (49/122)
Dyslipidemia	73.33% (11/15)	42.85% (6/14)	85% (17/20)	69.3% (34/49)

Boys


ALT U/L	≤25	>25-40	>40	Overall
NAFLD (USG)	25% (10/40)	22.2% (6/27)	76.47% (26/34)	41.5% (42/101)
Dyslipidemia	70%(7/10)	33.3% (2/6)	84.61% (22/26)	73.8%(31/42 )

Conclusion: The prevalence of NAFLD in obese children based on Liver USG in our population was very high (40.8%). Although USG may not be a very reliable way of diagnosing NAFLD, it is a warning to monitor for progression of liver disease in these children. We also found that 25/85 (29.4%) girls and boys with ALT levels below the recommended cut-offs of <22 and 25U/L respectively had NAFLD. This is a fairly large number of children in whom liver disease may be missed out if we follow the recommended ALT cut-offs. Hence we recommend that in our population all obese children should be screened for NAFLD by USG irrespective of the ALT levels.

ESPE Abstracts

P2-113