ALT helps spot liver fibrosis in overweight children

Alanine aminotransferase (ALT) appears to be a useful primary screening measure to identify early signs of fibrosis, such as increased liver stiffness, in children with overweight or obesity and additional risk factors, according to a study.

The study included 322 children (median age 13 years, 64 percent male, mean BMI z-score 3.5) with obesity or overweight plus at least one additional risk factor for metabolic dysfunction-associated steatotic liver disease (MASLD).

All children were screened for MASLD using ALT. They also underwent vibration-controlled transient elastography (VCTE) to assess for liver stiffness, with ≥7.4 kPa set as the threshold.

The prevalence of VCTE ≥7.4 kPa increased significantly with increasing ALT levels (p<0.001): 1.9 percent with normal ALT, 16.4 percent with mild ALT elevation (≥upper limit of normal [ULN]: 22 IU/L for girls, 26 IU/L for boys), 21.3 percent with moderate ALT elevation (≥twice the ULN: 44–79 IU/L for girls, 52–79 IU/L for boys), and 38.9 percent with significant ALT elevation (≥80 IU/L). No other noninvasive tests outperformed ALT in this cohort.

In logistic regression analysis, VCTE ≥7.4 kPa was associated with ALT ≥80 IU/L (odds ratio [OR], 2.91, 95 percent confidence interval [CI], 1.25–6.74), age (OR, 1.50, 95 percent CI, 1.27–1.76), male gender (OR, 2.37, 95 percent CI, 1.04–5.40), BMI z-score (OR, 3.01, 95 percent CI, 1.62–5.61), and HOMA-IR (OR, 1.10, 95 percent CI, 1.00–1.13).