Alanine aminotransferase cutoffs for the pediatric fatty liver disease: Major impact of the reference population

Author:

Aitokari Linnea1,Lahti Siiri1,Kivelä Laura123,Riekki Hanna1,Hiltunen Pauliina2,Vuorela Nina1,Viitasalo Anna4,Soininen Sonja45,Huhtala Heini6,Lakka Timo478,Kurppa Kalle129ORCID

Affiliation:

1. Tampere Center for Child, Adolescent and Maternal Health Research Tampere University Tampere Finland

2. Department of Pediatrics Tampere University Hospital Tampere Finland

3. Children's Hospital and Pediatric Research Center University of Helsinki and Helsinki University Hospital Helsinki Finland

4. Institute of Biomedicine University of Eastern Finland Kuopio Finland

5. Physician and Nursing Services, Health and Social Services Centre Wellbeing Services County of North Savo Varkaus Finland

6. Faculty of Social Sciences Tampere University Tampere Finland

7. Department of Clinical Physiology and Nuclear Medicine Kuopio University Hospital Kuopio Finland

8. Kuopio Research Institute of Exercise Medicine Kuopio Finland

9. The University Consortium of Seinäjoki Seinäjoki Finland

Abstract

AbstractObjectives and StudyThe often‐recommended alanine aminotransferase (ALT) cutoffs (girls 21 U/l, boys 25 U/l) are based on a NHANES cohort. A novel concept of metabolic dysfunction associated steatotic liver disease (MASLD) emphasizes the role of ALT. We tested the prevalence of increased ALT and MASLD in children with overweight or obesity applying population‐based and NHANES‐based cut‐offs.MethodsSix‐ to seventeen‐year‐old children underwent data collection in a prospective Physical Activity and Nutrition in Children (PANIC) study. ALT 95th percentiles were calculated from 1167 separate measurements considering various confounders. Test cohort comprised 1044 children with overweight/obesity.ResultsALT values increased at puberty onset (p = 0.031) and correlated negatively with age in girls (r = −0.222, p < 0.001). Particularly overall and central obesity increased ALT, whereas underweight or metabolic abnormalities had smaller effect. After applying the tested exclusions, the age‐related ALT 95th percentiles were 24–29 U/l for girls and 29–32 U/l for boys. In 6–8‐year‐old children with overweight/obesity, the prevalence of increased ALT and MASLD were 21.6% and 2.4% with age‐specific PANIC cutoffs. In older children, when NHANES‐based cutoffs were used, there was a trend for higher prevalence of increased ALT and MASLD in all age groups for both sexes, reaching significance for increased ALT in 12–16‐year‐old boys (NHANES 63.5%, 95% confidence interval [CI]: 56.4%–70.0% vs. PANIC 47.1%, 95% CI [40.1%–54.2%]) and 9–11‐year‐old girls (60.0% [49.4%–69.8%] vs. 31.8% [22.8%–42.3%]), respectively. Increased ALT/MASLD were more common in boys than in girls, and in boys these increased with age, whereas in girls these peaked at age 9–12 years.ConclusionA reference population impacts on the prevalence of increased ALT and MASLD. Considering this help optimizing screening while avoiding unnecessary investigations and surveillance. The prospective part of this study is registered in clinicaltrials.gov; identifier NCT01803776.

Publisher

Wiley

Subject

Gastroenterology,Pediatrics, Perinatology and Child Health

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