Yield of diagnostic tests in obese children with an elevated alanine aminotransferase

Bryan J. Rudolph, Yolanda Rivas, Shulamit Kulak, Debra H. Pan, Michelle R. Ewart, Terry L. Levin, John F. Thompson, Kathryn Scharbach

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Aim Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and affects roughly 10% of children. However, NAFLD is often diagnosed by exclusion - that is, obese children with an elevated alanine aminotransferase (ALT) are screened for other liver diseases in the absence of a biopsy. This testing is nonstandardized, and professional society recommendations differ. This study examines the yield of testing for disorders other than NAFLD in this patient population. Methods A retrospective study was performed in 120 obese, asymptomatic, noncholestatic children with an ALT ≥40 U/L and additional diagnostic testing. Results No patients were found to have Wilson's, hepatitis A, hepatitis B, hepatitis C, cytomegalovirus, alpha-1 antitrypsin deficiency, autoimmune hepatitis, celiac disease or Epstein-Barr virus. Only one patient (1/120) was identified with definite disease other than NAFLD, which was muscular dystrophy. The positive predictive value of a screening test was 5%, and the specificity was 97%. Of 70 children with an abdominal ultrasound, no significant abnormalities were identified. Conclusion Extensive testing in asymptomatic, noncholestatic, obese children with an elevated ALT may be of limited diagnostic value and false-positive tests are likely. Large, prospective studies are needed to help focus the work up in this patient population.

Original languageEnglish (US)
Pages (from-to)e557-e563
JournalActa Paediatrica, International Journal of Paediatrics
Volume104
Issue number12
DOIs
StatePublished - Dec 1 2015

Fingerprint

Alanine Transaminase
Routine Diagnostic Tests
alpha 1-Antitrypsin Deficiency
Autoimmune Hepatitis
Hepatitis A
Muscular Dystrophies
Celiac Disease
Hepatitis C
Hepatitis B
Cytomegalovirus
Human Herpesvirus 4
Population
Liver Diseases
Retrospective Studies
Obesity
Prospective Studies
Biopsy
Non-alcoholic Fatty Liver Disease

Keywords

  • Alanine Transaminase
  • Mass Screening
  • Nonalcoholic Fatty Liver Disease
  • Obesity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Yield of diagnostic tests in obese children with an elevated alanine aminotransferase. / Rudolph, Bryan J.; Rivas, Yolanda; Kulak, Shulamit; Pan, Debra H.; Ewart, Michelle R.; Levin, Terry L.; Thompson, John F.; Scharbach, Kathryn.

In: Acta Paediatrica, International Journal of Paediatrics, Vol. 104, No. 12, 01.12.2015, p. e557-e563.

Research output: Contribution to journalArticle

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abstract = "Aim Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and affects roughly 10{\%} of children. However, NAFLD is often diagnosed by exclusion - that is, obese children with an elevated alanine aminotransferase (ALT) are screened for other liver diseases in the absence of a biopsy. This testing is nonstandardized, and professional society recommendations differ. This study examines the yield of testing for disorders other than NAFLD in this patient population. Methods A retrospective study was performed in 120 obese, asymptomatic, noncholestatic children with an ALT ≥40 U/L and additional diagnostic testing. Results No patients were found to have Wilson's, hepatitis A, hepatitis B, hepatitis C, cytomegalovirus, alpha-1 antitrypsin deficiency, autoimmune hepatitis, celiac disease or Epstein-Barr virus. Only one patient (1/120) was identified with definite disease other than NAFLD, which was muscular dystrophy. The positive predictive value of a screening test was 5{\%}, and the specificity was 97{\%}. Of 70 children with an abdominal ultrasound, no significant abnormalities were identified. Conclusion Extensive testing in asymptomatic, noncholestatic, obese children with an elevated ALT may be of limited diagnostic value and false-positive tests are likely. Large, prospective studies are needed to help focus the work up in this patient population.",
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N2 - Aim Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and affects roughly 10% of children. However, NAFLD is often diagnosed by exclusion - that is, obese children with an elevated alanine aminotransferase (ALT) are screened for other liver diseases in the absence of a biopsy. This testing is nonstandardized, and professional society recommendations differ. This study examines the yield of testing for disorders other than NAFLD in this patient population. Methods A retrospective study was performed in 120 obese, asymptomatic, noncholestatic children with an ALT ≥40 U/L and additional diagnostic testing. Results No patients were found to have Wilson's, hepatitis A, hepatitis B, hepatitis C, cytomegalovirus, alpha-1 antitrypsin deficiency, autoimmune hepatitis, celiac disease or Epstein-Barr virus. Only one patient (1/120) was identified with definite disease other than NAFLD, which was muscular dystrophy. The positive predictive value of a screening test was 5%, and the specificity was 97%. Of 70 children with an abdominal ultrasound, no significant abnormalities were identified. Conclusion Extensive testing in asymptomatic, noncholestatic, obese children with an elevated ALT may be of limited diagnostic value and false-positive tests are likely. Large, prospective studies are needed to help focus the work up in this patient population.

AB - Aim Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and affects roughly 10% of children. However, NAFLD is often diagnosed by exclusion - that is, obese children with an elevated alanine aminotransferase (ALT) are screened for other liver diseases in the absence of a biopsy. This testing is nonstandardized, and professional society recommendations differ. This study examines the yield of testing for disorders other than NAFLD in this patient population. Methods A retrospective study was performed in 120 obese, asymptomatic, noncholestatic children with an ALT ≥40 U/L and additional diagnostic testing. Results No patients were found to have Wilson's, hepatitis A, hepatitis B, hepatitis C, cytomegalovirus, alpha-1 antitrypsin deficiency, autoimmune hepatitis, celiac disease or Epstein-Barr virus. Only one patient (1/120) was identified with definite disease other than NAFLD, which was muscular dystrophy. The positive predictive value of a screening test was 5%, and the specificity was 97%. Of 70 children with an abdominal ultrasound, no significant abnormalities were identified. Conclusion Extensive testing in asymptomatic, noncholestatic, obese children with an elevated ALT may be of limited diagnostic value and false-positive tests are likely. Large, prospective studies are needed to help focus the work up in this patient population.

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