Prevalence of Nonalcoholic Fatty Liver Disease in Children with Obesity

J Pediatr. 2019 Apr;207:64-70. doi: 10.1016/j.jpeds.2018.11.021. Epub 2018 Dec 14.


Objectives: To determine the prevalence of nonalcoholic fatty liver disease (NAFLD) in children with obesity because current estimates range from 1.7% to 85%. A second objective was to evaluate the diagnostic accuracy of alanine aminotransferase (ALT) for NAFLD in children with obesity.

Study design: We evaluated children aged 9-17 years with obesity for the presence of NAFLD. Diseases other than NAFLD were excluded by history and laboratories. Hepatic steatosis was measured by liver magnetic resonance imaging proton density fat fraction. The diagnostic accuracy of ALT for detecting NAFLD was evaluated.

Results: The study included 408 children with obesity that had a mean age of 13.2 years and mean body mass index percentile of 98.0. The study population had a mean ALT of 32 U/L and median hepatic magnetic resonance imaging proton density fat fraction of 3.7%. The estimated prevalence of NAFLD was 26.0% (95% CI 24.2%-27.7%), 29.4% in male patients (CI 26.1%-32.7%) and 22.6% in female patients (CI 16.0%-29.1%). Optimal ALT cut-point was 42 U/L (47.8% sensitivity, 93.2% specificity) for male and 30 U/L (52.1% sensitivity, 88.8% specificity) for female patients. The classification and regression tree model with sex, ALT, and insulin had 80% diagnostic accuracy for NAFLD.

Conclusions: NAFLD is common in children with obesity, but NAFLD and obesity are not concomitant. In children with obesity, NAFLD is present in nearly one-third of boys and one-fourth of girls.

Keywords: BMI; NAFLD; pediatric.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Alanine Transaminase / blood
  • Biomarkers / blood
  • Case-Control Studies
  • Child
  • Decision Trees
  • Female
  • Humans
  • Insulin / blood
  • Magnetic Resonance Imaging / methods
  • Male
  • Non-alcoholic Fatty Liver Disease / diagnostic imaging
  • Non-alcoholic Fatty Liver Disease / epidemiology*
  • Obesity / epidemiology*
  • Predictive Value of Tests
  • Prevalence


  • Biomarkers
  • Insulin
  • Alanine Transaminase