TY - JOUR
T1 - ALT Is an Effective Screening Tool for Advanced Metabolic Dysfunction-Associated Steatotic Liver Disease in Children With Obesity and Overweight
AU - Stroes, Anne-Sophie R.
AU - Draijer, Laura
AU - Chegary, Malika
AU - Kreier, Felix
AU - van Os, Erim
AU - Goede, Joery
AU - Boonstra, Venje
AU - Westerbeek, Ilse
AU - Bouma, Saskia
AU - Kusters, Meeike
AU - Roelants, Roosje
AU - Beuers, Ulrich
AU - Holleboom, Adriaan G.
AU - Benninga, Marc A.
AU - Koot, Bart G. P.
N1 - Publisher Copyright:
© 2025 The Author(s)
PY - 2025
Y1 - 2025
N2 - Background & Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in children with obesity and overweight. However, neither the optimal method nor risks and benefits of screening have been established. This study aims to evaluate the effectiveness of an alanine aminotransferase (ALT)-based screening algorithm for detecting those at risk of significant fibrosis. Methods: Children (aged 8–18 years) with (1) obesity or (2) overweight and ≥1 additional risk factor for MASLD were included. Participants were screened for MASLD using ALT and analyzed in 4 groups based on ALT levels. Vibration-controlled transient elastography (VCTE) was performed and analyzed at a threshold of ≥7.4 kPa. Patient features associated with VCTE ≥7.4 kPa were assessed using logistic regression analysis. Diagnostic accuracy of ALT was compared with other noninvasive tests. Results: Among 322 children (64% male; median age, 13 years; mean body mass index [BMI] z-score 3.5), the prevalence of VCTE ≥7.4 kPa increased significantly with ALT elevation: 1.9% for normal ALT, 16.4% for mild ALT elevation (≥ upper limit of normal [ULN]: female, 22 IU/L; male, 26 IU/L), 21.3% for moderate ALT elevation (≥2 ULN: female, 44–79 IU/L; male, 52–79 IU/L), and 38.9% for significant ALT elevation (≥80 IU/L) (P < .001). Other noninvasive tests did not perform superiorly in this cohort. VCTE ≥7.4 kPa was positively associated with ALT ≥80 IU/L (odds ratio [OR], 2.91; 95% confidence interval [CI], 1.25–6.74), age (OR, 1.50; 95% CI, 1.27–1.76), male gender (OR, 2.37; 95% CI, 1.04–5.40), BMI z-score (OR, 3.01; 95% CI, 1.62–5.61), and Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) (OR, 1.10; 95% CI, 1.00–1.13). Conclusions: This study shows that ALT is an effective primary screening step for increased liver stiffness, suggestive of significant fibrosis, in children with obesity or overweight and additional risk factors.
AB - Background & Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in children with obesity and overweight. However, neither the optimal method nor risks and benefits of screening have been established. This study aims to evaluate the effectiveness of an alanine aminotransferase (ALT)-based screening algorithm for detecting those at risk of significant fibrosis. Methods: Children (aged 8–18 years) with (1) obesity or (2) overweight and ≥1 additional risk factor for MASLD were included. Participants were screened for MASLD using ALT and analyzed in 4 groups based on ALT levels. Vibration-controlled transient elastography (VCTE) was performed and analyzed at a threshold of ≥7.4 kPa. Patient features associated with VCTE ≥7.4 kPa were assessed using logistic regression analysis. Diagnostic accuracy of ALT was compared with other noninvasive tests. Results: Among 322 children (64% male; median age, 13 years; mean body mass index [BMI] z-score 3.5), the prevalence of VCTE ≥7.4 kPa increased significantly with ALT elevation: 1.9% for normal ALT, 16.4% for mild ALT elevation (≥ upper limit of normal [ULN]: female, 22 IU/L; male, 26 IU/L), 21.3% for moderate ALT elevation (≥2 ULN: female, 44–79 IU/L; male, 52–79 IU/L), and 38.9% for significant ALT elevation (≥80 IU/L) (P < .001). Other noninvasive tests did not perform superiorly in this cohort. VCTE ≥7.4 kPa was positively associated with ALT ≥80 IU/L (odds ratio [OR], 2.91; 95% confidence interval [CI], 1.25–6.74), age (OR, 1.50; 95% CI, 1.27–1.76), male gender (OR, 2.37; 95% CI, 1.04–5.40), BMI z-score (OR, 3.01; 95% CI, 1.62–5.61), and Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) (OR, 1.10; 95% CI, 1.00–1.13). Conclusions: This study shows that ALT is an effective primary screening step for increased liver stiffness, suggestive of significant fibrosis, in children with obesity or overweight and additional risk factors.
KW - Elastography
KW - Liver Fibrosis
KW - Paediatric
KW - Prevalence
KW - Screening
UR - https://www.scopus.com/pages/publications/105012738238
U2 - 10.1016/j.cgh.2025.05.011
DO - 10.1016/j.cgh.2025.05.011
M3 - Article
C2 - 40518063
SN - 1542-3565
JO - Clinical gastroenterology and hepatology
JF - Clinical gastroenterology and hepatology
ER -
