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Article

Variation in Alanine Aminotransferase in Children with Non-Alcoholic Fatty Liver Disease

by
Eduardo Castillo-Leon
1,2,
Heather L. Morris
3,
Cheryl Schoen
3,
Jacob Bilhartz
4,
Patrick McKiernan
5,
Tamir Miloh
6,
Sirish Palle
7,
Mohammad Nasser Kabbany
8,
Breda Munoz
3,
Andrea R. Mospan
3,
Bryan Rudolph
9,
Stavra A. Xanthakos
10,
Miriam B. Vos
11,* and
TARGET-NASH Investigators
†
1
Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA 30322, USA
2
Department of Pediatrics, Morehouse School of Medicine, Atlanta, GA 30310, USA
3
Target RWE, Durham, NC 27703, USA
4
Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA
5
Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
6
Pediatric Gastroenterology, Pediatric Transplant Hepatology, Miami Transplant Institute, Miami, FL 33136, USA
7
Division of Gastroenterology, OU Medicine, Oklahoma City, OK 73104, USA
8
Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH 44195, USA
9
The Children’s Hospital at Montefiore, The Pediatric Hospital for Albert Einstein College of Medicine, Bronx, NY 10467, USA
10
Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA
11
Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
 
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*
Author to whom correspondence should be addressed.
†
Target-NASH Investigators: A complete list of investigators can be found in Appendix A Table A4.
Children 2022, 9(3), 374; https://doi.org/10.3390/children9030374
Submission received: 21 December 2021 / Revised: 3 February 2022 / Accepted: 17 February 2022 / Published: 8 March 2022
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Abstract

Background: Pediatric non-alcoholic fatty liver disease (NAFLD) is a major public health concern. Aminotransferase (ALT) is frequently used for screening and monitoring, but few studies have reported typical patterns of ALT elevation in children. Methods: TARGET-NASH is a real-world longitudinal observational cohort of patients with NAFLD receiving care across the United States. Analyses included children enrolled between 1 August 2016, and 12 October 2020, with at least one ALT measurement after enrollment. Peak ALT was based on the first and last available record and categorized into clinical cut points: <70 IU/L, >70–<250 IU/L, and >250 IU/L. A chi-squared test was used to compare differences in proportions, and a Kruskal–Wallis test was used to compare the medians and distributions of continuous responses. Results: Analyses included 660 children with a median age of 13 years. Of the 660, a total of 187 had undergone a biopsy and were more likely to be Hispanic or Latino (67% vs. 57%, p = 0.02) and to have cirrhosis (10% vs. 1%, p < 0.001). The highest ALT scores ranged from 28 U/L to 929 U/L; however, these scores varied across time. The prevalence of cirrhosis or any liver fibrosis stage was most common among children with a peak ALT > 70 U/L. Conclusions: Large variability was seen in ALT among children, including many values > 250 U/L. Higher levels of ALT were associated with increased prevalence of comorbidities and more advanced stages of NAFLD. These findings support an increased need for therapeutics and disease severity assessment in children with peak ALT > 70 U/L.
Keywords: cirrhosis; non-alcoholic fatty liver disease; ALT cirrhosis; non-alcoholic fatty liver disease; ALT

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MDPI and ACS Style

Castillo-Leon, E.; Morris, H.L.; Schoen, C.; Bilhartz, J.; McKiernan, P.; Miloh, T.; Palle, S.; Kabbany, M.N.; Munoz, B.; Mospan, A.R.; et al. Variation in Alanine Aminotransferase in Children with Non-Alcoholic Fatty Liver Disease. Children 2022, 9, 374. https://doi.org/10.3390/children9030374

AMA Style

Castillo-Leon E, Morris HL, Schoen C, Bilhartz J, McKiernan P, Miloh T, Palle S, Kabbany MN, Munoz B, Mospan AR, et al. Variation in Alanine Aminotransferase in Children with Non-Alcoholic Fatty Liver Disease. Children. 2022; 9(3):374. https://doi.org/10.3390/children9030374

Chicago/Turabian Style

Castillo-Leon, Eduardo, Heather L. Morris, Cheryl Schoen, Jacob Bilhartz, Patrick McKiernan, Tamir Miloh, Sirish Palle, Mohammad Nasser Kabbany, Breda Munoz, Andrea R. Mospan, and et al. 2022. "Variation in Alanine Aminotransferase in Children with Non-Alcoholic Fatty Liver Disease" Children 9, no. 3: 374. https://doi.org/10.3390/children9030374

APA Style

Castillo-Leon, E., Morris, H. L., Schoen, C., Bilhartz, J., McKiernan, P., Miloh, T., Palle, S., Kabbany, M. N., Munoz, B., Mospan, A. R., Rudolph, B., Xanthakos, S. A., Vos, M. B., & TARGET-NASH Investigators. (2022). Variation in Alanine Aminotransferase in Children with Non-Alcoholic Fatty Liver Disease. Children, 9(3), 374. https://doi.org/10.3390/children9030374

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