title: Prevalence, risk factors, and predictors of nonalcoholic fatty liver disease among schoolchildren: a hospital-based study in Alexandria, Egypt.
abstract: OBJECTIVE
  Nonalcoholic fatty liver disease (NAFLD) is an emerging problem in children and adolescents worldwide. This study was done to investigate the prevalence of NAFLD in children and adolescents as well as to determine the associated risk factors of fatty liver and to explore the ability of some obesity indices to predict and consequently be used as a screening method of fatty liver disease at certain cutoff points in schoolchildren.
  
  
  METHODS
  A cross-sectional, nested case-control study was carried out. Cases and controls were randomly selected from outpatient schoolchildren aged 6-18years attending the radiology clinic at Sporting Health Insurance Paediatric Hospital in Alexandria. They were subjected to ultrasonic examination as well as complete anthropometric and laboratory measurements including fasting plasma glucose (FPG) level, fasting insulin, alanine aminotransferase (ALT) level, and lipid profile.
  
  
  RESULTS
  Fatty liver was prevalent in schoolchildren (15.8%) and increased significantly with age (p=0.004). Positive family history of diabetes mellitus (DM), hypertension (HTN), obesity, and liver disease were all statistically significant risk factors for fatty liver. Waist circumference (WC), body mass index (BMI) and its Z-score were significantly sensitive predictors. BMI was considered the best predictor of paediatric NAFLD at a cutoff=22.9. NAFLD was significantly associated with high triglycerides (TGs), low high-density lipoprotein cholesterol (HDL), homoeostatic model assessment (HOMA) percentile, and the number of metabolic syndrome (MS) components.
  
  
  CONCLUSIONS
  Paediatric NAFLD is a substantial problem in schoolchildren and has a close relationship with obesity, dyslipidaemia, insulin resistance (IR), and consequently MS. BMI and WC can be used as useful predictors and screening tools for NAFLD in schoolchildren.
authors.affiliation: Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
authors.forename: Yasmine M
authors.initials: YM
authors.lastname: Alkassabany
authors.affiliation: Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
authors.forename: Azza G
authors.initials: AG
authors.lastname: Farghaly
authors.affiliation: Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt. Electronic address: ingy.elghitany@gmail.com.
authors.forename: Engy M
authors.initials: EM
authors.lastname: El-Ghitany
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D001249:Asthma / Q000453:epidemiology; D001327:Autoimmune Diseases / Q000453:epidemiology; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D016022:Case-Control Studies; D002648:Child; D008076:Cholesterol, HDL / Q000097:blood; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000235:genetics; D004534:Egypt / Q000453:epidemiology; D005215:Fasting; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000235:genetics; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D009765:Obesity / Q000453:epidemiology / Q000235:genetics; D015995:Prevalence; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D007328:Insulin; D014280:Triglycerides; D000410:Alanine Transaminase
keywords: Children; Fatty liver; Metabolic syndrome; Obesity; Predictor; Risk factors