Histological abnormalities in children with nonalcoholic fatty liver disease and normal or mildly elevated alanine aminotransferase levels - PubMed (original) (raw)

Histological abnormalities in children with nonalcoholic fatty liver disease and normal or mildly elevated alanine aminotransferase levels

Jean P Molleston et al. J Pediatr. 2014 Apr.

Abstract

Objective: To investigate the histological spectrum of nonalcoholic fatty liver disease (NAFLD) in children with normal, mildly elevated (26-50 U/L boys, 23-44 U/L girls), or elevated (>50 U/L in boys, >44 U/L in girls) serum alanine aminotransferase (ALT) levels.

Study design: The Nonalcoholic Steatohepatitis Clinical Research Network enrolls children aged 5-18 years with NAFLD. We analyzed baseline clinical and histological data from 91 children with suspected NAFLD and normal or mildly elevated ALT and liver biopsy analysis within 180 days of ALT measurement, and compared them with data from 392 children with elevated ALT.

Results: Seventeen of the 91 children with suspected NAFLD (19%) had a normal ALT level, and 74 (81%) had a mildly elevated ALT level. Overall, 45% of the biopsy specimens analyzed had steatosis ≥33%, 22% had grade ≥2 lobular inflammation, 81% had portal inflammation, 29% had ballooned hepatocytes, 35% had "suspicious/borderline" steatohepatitis, 8% had definite nonalcoholic steatohepatitis, 34% had an NAFLD activity score ≥4, and 46% had fibrosis (38% mild/moderate and 8% bridging/cirrhosis). Marked steatosis (50% vs 24%) and fibrosis (54% vs 12%) were significantly more common in the patients with mildly elevated ALT compared with those with normal ALT, with no difference in ballooning, inflammation, or NAFLD activity score ≥4 between the 2 groups. Fibrosis stage 3/4 was seen in none of the children with normal ALT, in 9% of those with mildly elevated ALT, and in 15% of those with elevated ALT.

Conclusion: Liver biopsy specimens from children with NAFLD with normal or mildly elevated ALT levels show significant histological abnormalities, including advanced fibrosis in children with mildly elevated ALT. Thus, measurement of ALT may underestimate liver injury in NAFLD. The use of appropriate ALT cutoff levels can help identify children at risk for more severe disease.

Trial registration: ClinicalTrials.gov NCT01061684.

Copyright © 2014 Mosby, Inc. All rights reserved.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1

Figure 1

Percent of children in each NASH diagnosis category for normal, mildly elevated, and elevated ALT. NASH diagnosis categories are NAFLD/no NASH, Borderline Zone 3 (1a), Borderline Zone 1 (1b), Definite (2).

Figure 2

Figure 2

Percent of biopsies in fibrosis stages None, Mild, Moderate, and Advanced for each ALT group.

Comment in

References

    1. Alisi A, Manco M, Vania A, Nobili V. Pediatric Nonalcoholic Fatty Liver Disease in 2009. J Pediatr. 2009;155:469–474. - PubMed
    1. Patton HM, Lavine JE, Van Natta ML, Schwimmer JB, Kleiner D, Molleston J. Clinical correlates of histopathology in pediatric nonalcoholic steatohepatitis. Gastroenterology. 2008;135:1961–1971. - PMC - PubMed
    1. Lavine JE, Schwimmer JB. Nonalcoholic fatty liver disease in the pediatric population. Clin Liver Dis. 2004;8:549–558. - PubMed
    1. Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120:S164–S192. - PubMed
    1. Strauss RS, Barlow SE, Dietz WH. Prevelance of abnormal serum aminotransferase values in overweight and obese adolescents. J Pediatr. 2000;136:727–733. - PubMed

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