title: Decreased prevalence of nonalcoholic fatty liver disease in black obese children.
abstract: OBJECTIVE
  Nonalcoholic fatty liver disease (NAFLD) is a common cause of pediatric liver disease. Studies suggest decreased prevalence in blacks, females, and younger children. However, the proportion of black subjects in these studies was small, and children under 12 were not included. We propose that abnormal alanine aminotransferase (ALT) is more common in whites than blacks, males than females, and children over 12 compared with younger children in a prospective study.
  
  
  METHODS
  We enrolled 181 consecutive asymptomatic obese children attending general pediatric clinics who denied recent fever or known liver disease. Obesity was defined as body mass index (BMI) z score of greater than 1.64 (95th percentile for age and sex). Elevated ALT was defined as greater than 40 U/L. BMI z score, race, sex, age, and parental obesity were compared using the chi-square test and Fisher's exact test.
  
  
  RESULTS
  The population included 81 males and 100 females, 147 non-Hispanic black, 33 non-Hispanic white, and 1 Hispanic white. Elevated ALT occurred in 14 (8%) subjects. White children were significantly more likely to have abnormal ALT (odds ratio [OR] = 4.0, P < .02). Very obese children (BMI z score >2.3) were more likely to have abnormal ALT compared with mildly obese children (OR = 4.0, P < 0.05). Sex, age, hepatomegaly, acanthosis nigricans, and parental obesity did not significantly predict elevated ALT.
  
  
  CONCLUSIONS
  Eight percent of asymptomatic, obese children had an elevated ALT suggestive of NAFLD. White and very obese children are more likely to be affected. Sex and age are not good clinical predictors of NAFLD. We suggest that all obese children be screened for NAFLD.
authors.affiliation: Department of Pediatrics, Division of Gastroenterology, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA. mvlout01@louisville.edu
authors.forename: Miriam V
authors.initials: MV
authors.lastname: Louthan
authors.forename: Judy A
authors.initials: JA
authors.lastname: Theriot
authors.forename: Ellen
authors.initials: E
authors.lastname: Zimmerman
authors.forename: John T
authors.initials: JT
authors.lastname: Stutts
authors.forename: Craig J
authors.initials: CJ
authors.lastname: McClain
mesh_terms: D000293:Adolescent; D001741:Black or African American; D000367:Age Factors; D000410:Alanine Transaminase / Q000378:metabolism; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005234:Fatty Liver / Q000201:enzymology / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology*; D008297:Male; D009765:Obesity / Q000150:complications*; D015995:Prevalence; D011446:Prospective Studies; D012737:Sex Factors; D044465:White People
chemical_list: D000410:Alanine Transaminase