Age- and ethnic-specific elevation of ALT among obese children at risk for nonalcoholic steatohepatitis (NASH): implications for screening

Clin Pediatr (Phila). 2009 Jan;48(1):50-7. doi: 10.1177/0009922808321678. Epub 2008 Oct 2.


The objectives are to: (1) characterize ethnic-specific differences in alanine aminotransferase (ALT) elevation among obese children, (2) investigate the earliest ages at which significant ALT elevation occurs, and (3) determine associations between ALT and biochemical parameters. A cohort of 134 multiethnic obese children and adolescents was analyzed retrospectively. ALT levels > or =45 U/L or <45 U/L, denoting high or normal risk, were used to categorize obese children's risk for developing nonalcoholic steatohepatitis. In all, 60% of Hispanics had high-risk ALT levels compared with 12% of whites and 8% of blacks. A significantly higher proportion of boys had ALT > or = 45 U/L (49.4%, vs 37.9% for girls, P = .002); 17.5% were Hispanic boys less than 7 years old. Obese Hispanic children, particularly boys, not only have higher ALT levels but present alarmingly young with high-risk levels. This study highlights a discrete subgroup of children who may present with fatty liver at a younger age and should be screened earlier.

MeSH terms

  • Adolescent
  • Age Factors
  • Alanine Transaminase / blood*
  • Black People
  • Child
  • Child, Preschool
  • Ethnicity
  • Fatty Liver / etiology*
  • Female
  • Hispanic or Latino
  • Humans
  • Male
  • Obesity / complications
  • Obesity / enzymology*
  • White People
  • Young Adult


  • Alanine Transaminase