Prevalence of non‐alcoholic fatty liver disease and its association with different combinations of weight status and metabolic abnormalities in children aged 6–18 years

ABSTRACT Importance Obesity and non‐alcoholic fatty liver disease (NAFLD) guidelines recommend screening for NAFLD in children with obesity or overweight plus metabolic abnormalities. However, which metabolic factor is more closely associated with NAFLD in children with overweight or obesity remains unknown, and the risk of NAFLD in non‐overweight children with metabolic abnormalities remains unclear. Objective We aimed to explore the prevalence of NAFLD and its association with different combinations of weight status and metabolic abnormalities in children aged 6–18 years. Methods Participants aged 6–18 years were recruited from the China Child and Adolescent NAFLD Study (CCANS). NAFLD was defined by ultrasonography or magnetic resonance imaging‐proton density fat fraction (MRI‐PDFF). Metabolic abnormalities include hypertension, hyperglycemia, hyperuricemia, high triglycerides (TG), low high‐density lipoprotein cholesterol, and high low‐density lipoprotein cholesterol. Multiple logistic regression models were used to assess the association of different combinations of weight statuses and metabolic abnormalities with NAFLD. Results A total of 11 760 participants were included. The prevalence of NAFLD increased with increasing weight status (1.1%, 13.7%, and 39.8% among children with non‐overweight, overweight, and obesity, respectively; P for trend < 0.001). The prevalence of NAFLD in boys and girls with general obesity was 45.0% and 28.6%, respectively. The prevalence of NAFLD in boys and girls with central obesity was 51.3% and 35.6%, respectively. After adjusting for confounding risk factors, the models revealed that in non‐overweight individuals, those with hyperglycemia (odds ratio [OR] = 7.46; 95% confidence interval [CI]: 2.39–23.26) or high TG levels (OR = 3.55; 95% CI: 1.39–9.06) had a significantly greater risk of NAFLD than those without. The odds ratio of NAFLD assessed in this study was greater in overweight individuals with hypertension, hyperuricemia, and high TG levels than in overweight individuals without metabolic abnormalities, with odds ratios ranging from 3.09 (95% CI: 1.24–7.67) to 4.48 (95% CI: 1.61–12.49). Interpretation Non‐overweight children with metabolic abnormalities might have an increased risk of NAFLD. These findings suggest that overweight and obesity should not be the sole criteria for NAFLD screening in children. In particular, more attention should be given to screening for NAFLD in non‐overweight children with metabolic abnormalities, as well as in overweight children.