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- Title
Yield of diagnostic tests in obese children with an elevated alanine aminotransferase.
- Authors
Rudolph, Bryan; Rivas, Yolanda; Kulak, Shulamit; Pan, Debra; Ewart, Michelle; Levin, Terry L.; Thompson, John F.; Scharbach, Kathryn
- Abstract
<bold>Aim: </bold>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.<bold>Methods: </bold>A retrospective study was performed in 120 obese, asymptomatic, noncholestatic children with an ALT ≥40 U/L and additional diagnostic testing.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.
- Subjects
CHILDHOOD obesity; ALANINE aminotransferase; THERAPEUTICS; ACQUISITION of data; FATTY liver; PEDIATRIC gastroenterology; DIAGNOSIS; DISEASE risk factors; LIVER disease diagnosis; OBESITY complications; LIVER diseases; OBESITY; RETROSPECTIVE studies
- Publication
Acta Paediatrica, 2015, Vol 104, Issue 12, pe557
- ISSN
0803-5253
- Publication type
journal article
- DOI
10.1111/apa.13176