Variation in Alanine Aminotransferase in Children with Non-Alcoholic Fatty Liver Disease
Eduardo Castillo-Leon,
Heather L. Morris,
Cheryl Schoen,
Jacob Bilhartz,
Patrick McKiernan,
Tamir Miloh,
Sirish Palle,
Mohammad Nasser Kabbany,
Breda Munoz,
Andrea R. Mospan,
Bryan Rudolph,
Stavra A. Xanthakos,
Miriam B. Vos,
TARGET-NASH Investigators
Affiliations
Eduardo Castillo-Leon
Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA 30322, USA
Heather L. Morris
Target RWE, Durham, NC 27703, USA
Cheryl Schoen
Target RWE, Durham, NC 27703, USA
Jacob Bilhartz
Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA
Patrick McKiernan
Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
Tamir Miloh
Pediatric Gastroenterology, Pediatric Transplant Hepatology, Miami Transplant Institute, Miami, FL 33136, USA
Sirish Palle
Division of Gastroenterology, OU Medicine, Oklahoma City, OK 73104, USA
Mohammad Nasser Kabbany
Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH 44195, USA
Breda Munoz
Target RWE, Durham, NC 27703, USA
Andrea R. Mospan
Target RWE, Durham, NC 27703, USA
Bryan Rudolph
The Children’s Hospital at Montefiore, The Pediatric Hospital for Albert Einstein College of Medicine, Bronx, NY 10467, USA
Stavra A. Xanthakos
Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA
Miriam B. Vos
Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
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: 70–250 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 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.
