Predictors and markers of hepatic fibrosis in obese children and adolescents

Objectives: Non-alcoholic fatty liver disease (NAFLD) is a progressive disease ranging from steatosis and fibrosis to cirrhosis. The limited chance of reversal of hepatic fibrosis makes its early identification desirable. The aim of the study was to identify the predictors and determinants of hepatic fibrosis in obese Indian children. Material and Methods: Serum alanine transaminase (ALT) levels and transient elastography (TE) (for controlled attenuation parameter [CAP] and liver stiffness measurement [LSM]) were assessed in 62 obese children (11.8 ± 2.7 years; body mass index standard deviation score [BMI SDS] 2.1 ± 0.5) and 61 age-matched controls (11.4 ± 3.4 years, BMI SDS −0.3 ± 0.9). Results: Serum ALT levels (50 ± 30 compared to 24 ± 11 IU/L, P < 0.001), CAP score (268 ± 57.0 compared to 176 ± 44.3 dB/m, P < 0.001), and LSM values (5.0 ± 1.5 compared to 4.3 ± 1.0 kPa, P = 0.002) were higher in obese subjects than controls. Steatosis (CAP above 240 dB/m, 59.5% compared to 6.5%, P < 0.001) and fibrosis (LSM above 7 kPA, 9.6% compared to 1.6%, P = 0.06) were more likely in obese subjects. BMI SDS was the only determinant of steatosis (standardized odds ratio 4.1, 95% confidence interval [CI] 1.1–10.4, P = 0.001) and fibrosis (standardized odds ratio 2.3, 95% CI: 1.2–9.8, P = 0.04). The area under the receiver operating characteristic curve for ALT levels for fibrosis and severe steatosis was 0.756 (95% CI: 0.48–1, P = 0.001) and 0.747 (95% CI: 0.619–0.875, P = 0.001), respectively. An ALT cutoff of 69 had 83% sensitivity and 82.1% specificity for hepatic fibrosis. Conclusion: The high prevalence of steatosis and fibrosis in obese children highlights the need for screening. Serum ALT levels above 69 IU/L suggest an increased risk of TE-identified fibrosis.