The incidence of nonalcoholic fatty liver disease (NAFLD) is increasing among children, but not all obese youngsters undergo recommended detection tests, a California study suggests.
The study
A group of researchers inspected Kaiser Permanent Southern California electronic medical record data from members ages 5 to 18 between 2009 and 2018, with records from a total of 7.88 million patients per year. During the study, 54% of children with obesity and 24% of overweight children underwent nonalcoholic fatty liver detection tests.
From 2009 to 2018, the incidence of NAFLD among the children in the study increased from 36.0 to 58.2 per 100,000. A total of 3,608 children were diagnosed with NAFLD during the study, according to the Pediatrics report. NAFLD diagnoses are becoming more common, in part, because clinical guidelines from several medical societies, including the American Academy of Pediatrics, recommend detection tests for children with a high BMI and because an increasing number of youngsters have risk factors for the disease, such as obesity, diabetes and high triglycerides; main author of the study, Dr. Jeffrey Schwimmer said. He is a professor of pediatrics at the University of California, San Diego and director of the Fatty Liver Clinic at Rady Children’s Hospital in San Diego.
Nonalcoholic fatty liver disease (NAFLD) found in children
“In our current study, we observed that the detection rate by primary care physicians increased in response to societal guidelines,” Dr. Schwimmer stated on an email. “A higher number of children who are diagnosed with NAFLD is due in part to the fact that there are more children with the problem, and partly because the problem is detected more effectively.”
During the study period, there was a total of 206,117 obese children that received follow-up visits, and 54% of them underwent nonalcoholic fatty liver detection tests. Moreover, there was a total of 212,710 overweight children who received a follow-up visit and 24% of them underwent nonalcoholic fatty liver detection tests. Among obese children who underwent NAFLD detection tests, the possibility of a referral for additional evaluation was more likely from 2012 to 2018 than from 2009 to 2011 (probability ratio 1.38).
The possibility of a referral for additional evaluation also increased when children showed higher alanine aminotransferase (ALT) values ??and results that were higher than the normal upper limit (ULN) of 54 U/L for Kaiser Permanente Southern California.
Some limitations
One limitation of the study is that physicians did not generally use liver histology to diagnose NAFLD, which makes it possible for some diagnoses to be inaccurate, the study team noted. The researchers also lacked data on what proportion of children with NAFLD may also have had fibrosis or NASH.
Another downside is that the blood pressure and high levels of insulin of the children in the study were not routinely reported, making it difficult to determine how many of them may have had metabolic syndrome, Dr. Pietro Vajro said. He is a professor of pediatrics at the University of Salerno and director of the pediatrics residency program at the University Hospital of Salerno, in Italy.
Nevertheless, the results highlight that more physicians need to detect NAFLD and discuss risk factors for the disease with parents of children who are more likely to develop the disease, Dr. Vajro said. He did not participate in the study, by email. “Previous research has found that the majority of overweight children assisted in general and subspecialty patient clinics in the US were not diagnosed and/or did not receive relevant and recommended assessments and interventions for obesity comorbidities, including NAFLD.” Dr. Vajro said.
Reference: Sahota AK, Shapiro WL, Newton KP, et al. Incidence of Nonalcoholic Fatty Liver Disease in Children: 2009-2018. Pediatrics. 2020 Nov 19:e20200771.
Link: https://www.sochob.cl/web1/la-prevalencia-de-nafld-aumenta-entre-los-ninos-pero-muchos-no-han-sido-diagnosticados/
Date: November 22nd, 2020
Source: https://www.medscape.com
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