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Multicenter Study
. 2020 Dec;146(6):e20200771.
doi: 10.1542/peds.2020-0771.

Incidence of Nonalcoholic Fatty Liver Disease in Children: 2009-2018

Amandeep K Sahota  1   2 , Warren L Shapiro  1   3   4   2 , Kimberly P Newton  3   4 , Steven T Kim  1 , Joanie Chung  1 , Jeffrey B Schwimmer  5   4
Affiliations
Multicenter Study

Incidence of Nonalcoholic Fatty Liver Disease in Children: 2009-2018

Amandeep K Sahota et al. Pediatrics. 2020 Dec.

Abstract

Background and objectives: In 2007, the American Academy of Pediatrics recommended that children with obesity should be screened for nonalcoholic fatty liver disease (NAFLD). Population epidemiology reveals that NAFLD is common in children; however, little is known about rates of clinical diagnosis. In this study, we aim to determine screening practices, annual incidence, and clinical characteristics of NAFLD in children within an integrated community health system.

Methods: Using electronic health records, we identified patients newly diagnosed (aged 5-18) with NAFLD on the basis of diagnostic codes from the 9th and 10th revisions of the International Classification of Diseases. We calculated screening rates and annual incidence rates of NAFLD from January 1, 2009, to December 31, 2018.

Results: In this study, we evaluated 7 884 844 patient-years. Screening was performed in 54.0% of children with obesity and 24.0% of children with overweight. The results revealed 36 658 children aged 9 to 18 with overweight or obesity and alanine aminotransferase >30 U/L. Of these children, 12.3% received further workup for NAFLD. The incidence of an NAFLD diagnosis significantly increased over time, with 36.0 per 100 000 in 2009 and 58.2 per 100 000 in 2018 (P < .0001).

Conclusions: Our study of a large integrated health care system in southern California revealed that the incidence of NAFLD in children is increasing, although many children may remain undiagnosed.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Age distribution of children with NAFLD at diagnosis. During the study period, there were 3608 children newly diagnosed with NAFLD. The histogram reveals the percentage of these patients by their age at the time of diagnosis.
FIGURE 2
FIGURE 2
Distribution of ALT in children with NAFLD. For children with NAFLD, the distribution for ALT is shown by multiples of the ULN used in the clinical laboratory. The ULN for ALT was 54 U/L.
See this image and copyright information in PMC

References

    1. Welsh JA, Karpen S, Vos MB. Increasing prevalence of nonalcoholic fatty liver disease among United States adolescents, 1988-1994 to 2007-2010. J Pediatr. 2013;162(3):496–500.e1 - PMC - PubMed
    1. Temple JL, Cordero P, Li J, Nguyen V, Oben JA. A guide to non-alcoholic fatty liver disease in childhood and adolescence. Int J Mol Sci. 2016;17(6):947 - PMC - PubMed
    1. Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of fatty liver in children and adolescents. Pediatrics. 2006;118(4):1388–1393 - PubMed
    1. Fernandes DM, Pantangi V, Azam M, et al. . Pediatric nonalcoholic fatty liver disease in New York City: an autopsy study. J Pediatr. 2018;200:174–180 - PubMed
    1. Riley MR, Bass NM, Rosenthal P, Merriman RB. Underdiagnosis of pediatric obesity and underscreening for fatty liver disease and metabolic syndrome by pediatricians and pediatric subspecialists. J Pediatr. 2005;147(6):839–842 - PubMed

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