Paediatric gastroenterology evaluation of overweight and obese children referred from primary care for suspected non-alcoholic fatty liver disease
Jeffrey B. Schwimmer,Jeffrey B. Schwimmer,Kimberly P. Newton,Kimberly P. Newton,Hannah I. Awai,Hannah I. Awai,L. J. Choi,L. J. Choi,M. A. Garcia,M. A. Garcia,L. L. Ellis,L. L. Ellis,L. L. Ellis,K. Vanderwall,J. Fontanesi +14 more
TLDR
Screening overweight and obese children for non‐alcoholic fatty liver disease (NAFLD) is recommended by paediatric and endocrinology societies, but gastroenterology societies have called for more data before making a formal recommendation.Abstract:
Author(s): Schwimmer, JB; Newton, KP; Awai, HI; Choi, LJ; Garcia, MA; Ellis, LL; Vanderwall, K; Fontanesi, J | Abstract: BackgroundScreening overweight and obese children for non-alcoholic fatty liver disease (NAFLD) is recommended by paediatric and endocrinology societies. However, gastroenterology societies have called for more data before making a formal recommendation.AimTo determine whether the detection of suspected NAFLD in overweight and obese children through screening in primary care and referral to paediatric gastroenterology resulted in a correct diagnosis of NAFLD.MethodsInformation generated in the clinical evaluation of 347 children identified with suspected NAFLD through screening in primary care and referral to paediatric gastroenterology was captured prospectively. Diagnostic outcomes were reported. The diagnostic performance of two times the upper limit of normal (ULN) for alanine aminotransferase (ALT) was assessed.ResultsNon-alcoholic fatty liver disease was diagnosed in 55% of children identified by screening and referral. Liver disease other than NAFLD was present in 18% of those referred. Autoimmune hepatitis was the most common alternative diagnosis. Children with NAFLD had significantly (P l 0.05) higher screening ALT (98 ± 95) than children with liver disease other than NAFLD (86 ± 74). Advanced fibrosis was present in 11% of children. For the diagnosis of NAFLD, screening ALT two times the clinical ULN had a sensitivity of 57% and a specificity of 71%.ConclusionsScreening of overweight and obese children in primary care for NAFLD with referral to paediatric gastroenterology has the potential to identify clinically relevant liver pathology. Consensus is needed on how to value the risk and rewards of screening and referral, to identify children with liver disease in the most appropriate manner.read more
Citations
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Journal ArticleDOI
The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases.
Naga Chalasani,Zobair M. Younossi,Joel E. Lavine,Michael Charlton,Kenneth Cusi,Mary E. Rinella,Stephen A. Harrison,Elizabeth M. Brunt,Arun J. Sanyal +8 more
TL;DR: This guidance provides a data-supported approach to the diagnostic, therapeutic, and preventive aspects of NAFLD care.
Journal ArticleDOI
NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children: Recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN)
Miriam B. Vos,Miriam B. Vos,Stephanie H. Abrams,Sarah E. Barlow,Sonia Caprio,Stephen R. Daniels,Stephen R. Daniels,Rohit Kohli,Rohit Kohli,Marialena Mouzaki,Marialena Mouzaki,Pushpa Sathya,Pushpa Sathya,Jeffrey B. Schwimmer,Jeffrey B. Schwimmer,Jeffrey B. Schwimmer,Shikha S. Sundaram,Shikha S. Sundaram,Stavra A. Xanthakos,Stavra A. Xanthakos +19 more
TL;DR: This guideline is designed to guide screening and clinical care of children with nonalcoholic fatty liver disease and is a management challenge for general pediatric practitioners, subspecialists and for health systems.
Journal ArticleDOI
Prevalence of Prediabetes and Type 2 Diabetes in Children With Nonalcoholic Fatty Liver Disease.
Kimberly P. Newton,Kimberly P. Newton,Jiayi Hou,Nancy A. Crimmins,Nancy A. Crimmins,Joel E. Lavine,Sarah E. Barlow,Stavra A. Xanthakos,Stavra A. Xanthakos,Jonathan A. Africa,Jonathan A. Africa,Cynthia Behling,Cynthia Behling,Michele Donithan,Jeanne M. Clark,Jeanne M. Clark,Jeffrey B. Schwimmer,Jeffrey B. Schwimmer +17 more
TL;DR: Nearly 30% of children with NAFLD also had type 2 diabetes or prediabetes, and these children had greater odds of having NASH and thus were at greater long-term risk for adverse hepatic outcomes.
Journal ArticleDOI
Update to the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement
Richard G. Barr,Stephanie R. Wilson,Deborah J. Rubens,Guadalupe Garcia-Tsao,Giovanna Ferraioli +4 more
TL;DR: This multidisciplinary update of the Society of Radiologists in Ultrasound consensus statement on liver elastography incorporates the large volume of new information available in the literature since the initial publication.
Journal ArticleDOI
A Guide to Non-Alcoholic Fatty Liver Disease in Childhood and Adolescence
TL;DR: Given the current absence of definitive radiological and histopathological diagnostic tests, maintenance of a high clinical suspicion by all members of the multidisciplinary team in primary and specialist care settings remains the most potent of diagnostic tools, enabling early diagnosis and appropriate therapeutic intervention.
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