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

• Type of Material: Article
• Authors: Eduardo Castillo-Leon, Emory University; Heather L. Morris, Target RWE; Cheryl Schoen, Target RWE; Jacob Bilhartz, University of Michigan; Patrick McKiernan, Children’s Hospital of Pittsburgh; Tamir Miloh, Miami Transplant Institute; Sirish Palle, Oklahoma University; Mohammad Nasser Kabbany, Cleveland Clinic; Breda Munoz, Target RWE; Andrea R. Mospan, Target RWE; Bryan Rudolph, Albert Einstein College of Medicine; Stavra A. Xanthakos, University of Cincinnati; Miriam Vos, Emory University
• Language: English
• Date: 2022-03-08
• Publisher: Wiley
• Publication Version: Final Published Version
• Copyright Statement: © 2022 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/children9030374
• Title of Journal or Parent Work: Children & Society
• Volume: 9
• Issue: 3
• Grant/Funding Information: Target RWE is the sponsor of the TARGET-NASH study and is solely responsible for data collection and analysis and the decision to publish, as well as preparation of the manuscript with co-authors. TARGET-NASH is a collaboration among academic and community investigators and the pharmaceutical industry.
• Keywords: ALT; cirrhosis; non-alcoholic fatty liver disease
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Cell

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.