Hepatic steatosis was common among overweight and Hispanic adolescent and young adult females, according to new research data.
Jennifer L. Rehm, MD, department of pediatrics, University of Wisconsin School of Medicine and Public Health, and colleagues assessed alanine aminotransferase (ALT) levels, BMI and other metabolic markers for 136 adolescent and young adult females, aged 11 to 22 years. The researchers sought to develop a risk assessment model for early detection of hepatic steatosis.
Jennifer L. Rehm
Sixteen percent of patients with an MRI proton density fat fraction greater than 5.5% had hepatic steatosis, 54.5% of whom were Hispanic (OR=4.26; 95% CI, 1.65-11.04). Among patients with hepatic steatosis, 20 were overweight, while 55 patients who were overweight did not have hepatic steatosis.
Metabolic syndrome with insulin resistance was evident in 12 overweight patients with hepatic steatosis (60%) compared with 15 of the overweight patients without hepatic steatosis (27%), increassing the risk for hepatic steatosis by nearly fivefold (OR=4.95; 95% CI, 1.66-14.78). In the risk assessment model that included ethnicity, fasting insulin, waist circumference and total cholesterol, sensitivity, specificity and positive predictive value (PPV) were 64%, 99% and 93%, respectively. This compared favorably with a low sensitivity (9%) when combining a BMI greater than the 85th percentile with ALT greater than 65 U/L or a low PPV (47%) when combined with a reduced ALT level (24 U/L).
Researchers found the homeostatic model of assessment-insulin resistance (OR=1.46; 95% CI, 1.22-1.76) and triglycerides (OR=1.02; 95% CI, 1.002-1.026) to be independent predictors for hepatic steatosis.
“Hepatic steatosis is common in overweight girls, particularly those of Hispanic ethnicity, and BMI and ALT screening alone misses the majority of subjects with hepatic steatosis,” Rehm told Healio.com/Hepatology. “Early detection is important because even a modest amount of hepatic fat is associated with metabolic disease, which may contribute to the progression to [nonalcoholic steatohepatitis].
“Incorporation of a clinically feasible risk assessment model with a high predictive value for [nonalcoholic fatty liver disease], such as the one proposed in this study, could guide efficient use of biopsy or imaging for detection of early hepatic steatosis in children and adolescents.”
Disclosure: The researchers report no relevant financial disclosures.