Abstract
(1) Background: Alanine aminotransferase (ALT) is used to screen for non-alcoholic fatty liver disease (NAFLD) in children; however, the optimal age to commence screening is not determined. Our objective was to describe whether ALT trends from 9–24 years were associated with hepatic steatosis at 24 years in a population-based UK cohort. (2) Methods: The sample included 1156 participants who were assessed for hepatic steatosis at 24 years and had at least two ALT measurements at 9, 15, 17, and/or 24 years. Controlled attenuation parameter scores were used to assess steatosis (low (<248 dB/m), mild/moderate (248–279 dB/m), severe (>279 dB/m)). Sex-stratified mixed-effects models were constructed to assess the liver enzyme trends by steatosis level. (3) Results: The final sample was 41.4% male and 10.4% had severe steatosis. In both sexes, ALT trends from 9 to 24 years differed in those with low vs. severe steatosis at 24 years (p < 0.001). There was no evidence of differences prior to puberty. At 17 years, the low vs. severe geometric mean ratio (GMR) was 0.69, 95% CI: 0.57–0.85 in males and (0.81, 0.65–1.01) females. At 24 years, the GMR was (0.53, 0.42–0.66) in males and (0.67, 0.54–0.84) females. (4) Conclusions: Higher ALT concentration in adolescence was associated with hepatic steatosis at 24 years. The increased screening of adolescents could strengthen NAFLD prevention and treatment efforts.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome [1].NAFLD is defined as having steatosis involving greater than 5% hepatocytes, typically assessed by liver biopsy or imaging, in the absence of other causes of hepatic steatosis including heavy alcohol intake [2]
We describe the trends in ALT and other liver enzyme concentrations in the UK population-based Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort from 9 to 24 years and determine whether these trends differ by category of hepatic steatosis at 24 years
There was differential loss to follow-up within the cohort, whereby females and participants with mothers with higher education were more likely to be followed-up. This is the first description of liver enzyme trends extending from childhood to adulthood and their relation with later hepatic steatosis
Summary
Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome [1]. NAFLD is defined as having steatosis involving greater than 5% hepatocytes, typically assessed by liver biopsy or imaging, in the absence of other causes of hepatic steatosis including heavy alcohol intake [2]. The prevalence of NAFLD has increased considerably over recent decades in youth in parallel with the rise of obesity [3]. This is concerning because pediatric NAFLD can progress to nonalcoholic steatohepatitis (NASH), which is characterized by inflammation, as well as cirrhosis and end stage liver disease in adulthood [4].
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