Possible prediction of obesity-related liver disease in children and adolescents using indices of body composition

Magnus Jung Johansen, Morten Asp Vonsild Lund, Lars Ängquist, Cilius Esmann Fonvig, Louise Aas Holm, Elizaveta Chabanova, Henrik S Thomsen, Torben Hansen, Jens-Christian Holm, Magnus Jung Johansen, Morten Asp Vonsild Lund, Lars Ängquist, Cilius Esmann Fonvig, Louise Aas Holm, Elizaveta Chabanova, Henrik S Thomsen, Torben Hansen, Jens-Christian Holm

Abstract

Background: Diagnosis of nonalcoholic fatty liver disease in children and adolescents currently requires advanced or invasive technologies.

Objectives: We aimed to develop a method to improve diagnosis, using body composition indices and liver biochemical markers.

Methods: To diagnose non-alcoholic fatty liver disease, 767 Danish children and adolescents underwent clinical examination, blood sampling, whole-body dual-energy X-ray absorptiometry scanning and proton magnetic resonance spectroscopy for liver fat quantification. Fourteen variables were selected as a starting point to construct models, narrowed by stepwise selection. Individuals were split into a training set for model construction and a validation test set. The final models were applied to 2120 Danish children and adolescents to estimate the prevalence.

Results: The final models included five variables in different combinations: body mass index-standard deviation score, android-to-gynoid-fat ratio, android-regional fat percent, trunk-regional fat percent and alanine transaminase. When validated, the sensitivity and specificity ranged from 38.6% to 51.7% and 87.6% to 91.9%, respectively. The estimated prevalence was 24.2%-35.3%. Models including alanine transaminase alongside body composition measurements displayed higher sensitivity.

Conclusions: Body composition indices and alanine transaminase can be used to estimate non-alcoholic fatty liver disease, with 38.6%-51.7% sensitivity and 87.6%-91.9%, specificity, in children and adolescents with overweight (including obesity). These estimated a 24.2%-35.3% prevalence in 2120 patients.

Trial registration: ClinicalTrials.gov NCT00928473.

Keywords: DXA-scan; MAFLD; NAFLD; adolescents; body composition; children.

Conflict of interest statement

All authors have nothing to disclose.

© 2022 The Authors. Pediatric Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.

Figures

FIGURE 1
FIGURE 1
Receiver operating characteristic (ROC) curves for determining optimal cut‐off, based on the Youden index optimality criterion, for predicting NAFLD in models A.1 and C.4. The area under the curve (AUC) was 81.0% for model A.1 with the probability cut‐off of 0.25, which predicted NAFLD with a sensitivity of 77% and a specificity of 70%. The AUC was 83.4% for model C.4, with cut‐off of 0.36, which predicted NAFLD with a sensitivity of 72% and a specificity of 82%

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