Non-Alcoholic Fatty Liver Disease (NAFLD)

Non-alcoholic fatty liver disease is a common cause of elevated transaminases and can cause chronic liver disease in obese children.

It has been reported that from 10-25 percent of obese children have elevated aminotransferase (ALT). In one study of children with fatty liver, 63 percent demonstrated liver fibrosis. Fibrosis is associated with increasing BMI, insulin resistance and older age.

Most children are relatively asymptomatic; however, they may present with right upper quadrant pain, abdominal discomfort or jaundice. Characteristic biochemical findings in children with NAFLD include 3- to 4-fold elevations in hepatic transaminases with normal bilirubin and normal alkaline phosphatase levels.

With an ALT>60, obtain full liver profile, GGT, albumin, and PT/PTT in 2-3 months. If ALT is increasing and/or greater than 100, the following liver conditions need to be excluded:

• Wilson’s disease
• Alpha 1 antitrypsin
• Autoimune hepatitis
• Viral hepatitis
• Alcohol ingestion and other toxins

To exclude these conditions, obtain ceruloplasmin, alpha 1 antitrypsin level, hepatitis screen, sed rate, ana, antismooth muscle antibody, and anti-liver and kidney microsomal antibodies (anti-lkm). Obtain an ultrasound of the liver and consult with pediatric hepatology.

A liver biopsy is required for a definitive diagnosis of Non-Alcoholic Steato-Hepatitis. Healthy eating and physical activity have been demonstrated to decrease BMI, levels of fasting glucose, lipids, liver enzymes and liver echogenicity on ultrasound.