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. 2023 Jul 1;77(1):103-109.
doi: 10.1097/MPG.0000000000003795. Epub 2023 Apr 21.

Prevalence of Elevated ALT in Adolescents in the US 2011-2018

Anna K Mischel  1 , Zhengxu Liao  2 , Fangyi Cao  2 , Winston Dunn  3 , Joan C Lo  4   5 , Kimberly P Newton  1   6 , Nidhi P Goyal  1   6 , Elizabeth L Yu  1   6 , Jeffrey B Schwimmer  1   6
Affiliations

Prevalence of Elevated ALT in Adolescents in the US 2011-2018

Anna K Mischel et al. J Pediatr Gastroenterol Nutr. .

Abstract

Objective: The objective of this study is to characterize suspected nonalcoholic fatty liver disease (NAFLD) using elevated alanine aminotransferase (ALT) in a diverse and nationally representative cohort of adolescents and to characterize higher ALT elevation in adolescents with obesity.

Methods: Data from the National Health and Nutrition Examination Survey 2011-2018 were analyzed for adolescents 12-19 years. Participants with causes for elevated ALT other than NAFLD were excluded. Race and ethnicity, sex, body mass index (BMI), and ALT were examined. Elevated ALT was defined as >22 U/L (females) and >26 U/L (males) using the biologic upper normal limit (ULN). Elevated ALT thresholds up to 2X-ULN were examined among adolescents with obesity. Multivariable logistic regression was used to determine the association of race/ethnicity and elevated ALT, adjusting for age, sex, and BMI.

Results: Prevalence of elevated ALT in adolescents was 16.5% overall and 39.5% among those with obesity. For White, Hispanic, and Asian adolescents, prevalence was 15.8%, 21.8%, and 16.5% overall, 12.8%, 17.7%, and 27.0% in those with overweight, and 43.0%, 43.5%, and 43.1% in those with obesity, respectively. Prevalence was much lower in Black adolescents (10.7% overall, 8.4% for overweight, 20.7% for obesity). Prevalence of ALT at 2X-ULN was 6.6% in adolescents with obesity. Hispanic ethnicity, age, male sex, and higher BMI were independent predictors of elevated ALT.

Conclusions: Prevalence of elevated ALT in U.S. adolescents is high, affecting 1 in 6 adolescents during 2011-2018. The risk is highest in Hispanic adolescents. Asian adolescents with elevated BMI may comprise an emerging risk group for elevated ALT.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Figure shows the prevalence of elevated alanine aminotransferase (ALT) across a continuous threshold from the upper normal limit (ULN) to 2X-ULN of ALT for adolescents with obesity categorized by self-reported race or ethnicity.
See this image and copyright information in PMC

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