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Meta-Analysis
. 2015 Oct 29;10(10):e0140908.
doi: 10.1371/journal.pone.0140908. eCollection 2015.

The Prevalence of Non-Alcoholic Fatty Liver Disease in Children and Adolescents: A Systematic Review and Meta-Analysis

Emma L Anderson  1 , Laura D Howe  1 , Hayley E Jones  2 , Julian P T Higgins  3 , Debbie A Lawlor  1 , Abigail Fraser  1
Affiliations
Meta-Analysis

The Prevalence of Non-Alcoholic Fatty Liver Disease in Children and Adolescents: A Systematic Review and Meta-Analysis

Emma L Anderson et al. PLoS One. .

Abstract

Background & aims: Narrative reviews of paediatric NAFLD quote prevalences in the general population that range from 9% to 37%; however, no systematic review of the prevalence of NAFLD in children/adolescents has been conducted. We aimed to estimate prevalence of non-alcoholic fatty liver disease (NAFLD) in young people and to determine whether this varies by BMI category, gender, age, diagnostic method, geographical region and study sample size.

Methods: We conducted a systematic review and meta-analysis of all studies reporting a prevalence of NAFLD based on any diagnostic method in participants 1-19 years old, regardless of whether assessing NAFLD prevalence was the main aim of the study.

Results: The pooled mean prevalence of NAFLD in children from general population studies was 7.6% (95%CI: 5.5% to 10.3%) and 34.2% (95% CI: 27.8% to 41.2%) in studies based on child obesity clinics. In both populations there was marked heterogeneity between studies (I2 = 98%). There was evidence that prevalence was generally higher in males compared with females and increased incrementally with greater BMI. There was evidence for differences between regions in clinical population studies, with estimated prevalence being highest in Asia. There was no evidence that prevalence changed over time. Prevalence estimates in studies of children/adolescents attending obesity clinics and in obese children/adolescents from the general population were substantially lower when elevated alanine aminotransferase (ALT) was used to assess NAFLD compared with biopsies, ultrasound scan (USS) or magnetic resonance imaging (MRI).

Conclusions: Our review suggests the prevalence of NAFLD in young people is high, particularly in those who are obese and in males.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study Selection.
Fig 2
Fig 2. Estimates of the prevalence of NAFLD in children from general population studies.
Overall mean estimate and prediction intervals are calculated from a random effects meta-analysis.
Fig 3
Fig 3. Estimates of the prevalence of NAFLD in children from clinical obese population studies.
Overall mean estimate and prediction intervals are calculated from a random effects meta-analysis.
Fig 4
Fig 4. Meta-analysis of within-study comparisons of NAFLD prevalence in males versus females in general population studies.
Fig 5
Fig 5. Meta-analysis of within-study comparisons of NAFLD prevalence in males versus females in clinical population studies.
See this image and copyright information in PMC

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