Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children

Screening should be considered beginning between ages 9 and 11 years for all obese children (BMI ≥95th percentile) and for overweight children (BMI ≥85th and <94th percentile) with additional risk factors (central adiposity, insulin resistance, prediabetes or diabetes, dyslipidemia, sleep apnea, or family history of NAFLD/NASH). (Moderate, Strong)

Earlier screening can be considered in younger patients with risk factors such as severe obesity, family history of NAFLD/NASH, or hypopituitarism. (Moderate, Weak)

Consider screening of siblings and parents of children with NAFLD if they have known risk factors for NAFLD (obesity, Hispanic ethnicity, insulin resistance, prediabetes, diabetes, dyslipidemia). (Low, Weak)

Interpretation of ALT should be based upon sex-specific upper limits of normal in children (22 U/L for girls and 26 U/L for boys) and not individual laboratory upper limits of normal. (High, Strong)

Persistently (>3 months) elevated ALT more than twice the upper limit of normal should be evaluated for NAFLD or other causes of chronic hepatitis. (Low, Strong)

ALT of >80 U/L warrants increased clinical concern and timely evaluation, as the likelihood of significant liver disease is higher. (Low, Weak)

Clinically available routine ultrasound is not recommended as a screening test for NAFLD in children due to inadequate sensitivity and specificity. (Moderate, Strong)

When the initial screening test is normal, consider repeating ALT every 2 to 3 years if risk factors remain unchanged. (Low, Weak)

Consider repeating screening sooner if clinical risk factors of NAFLD increase in number or severity. Examples include excessive weight gain or development of other medical problems that increase risk of NAFLD, such as type 2 diabetes or OSA. (Low, Weak)