title: A clinically relevant method to screen for hepatic steatosis in overweight adolescents: a cross sectional study.
abstract: BACKGROUND
  To develop a screening algorithm to detect hepatic steatosis in overweight and obese adolescents.
  
  
  METHODS
  We performed a cross sectional study of 129 overweight adolescents 13-18 yrs. The primary outcome, hepatic steatosis was defined as an intracellular triglyceride content > 5.5 mg/g and quantified using (1)H-magenetic resonance spectroscopy. Primary predictor variables included, alanine and aspartate transaminases (ALT/AST) and features of the metabolic syndrome.
  
  
  RESULTS
  Hepatic steatosis was present in 33% of overweight and obese adolescents. Adolescents with hepatic steatosis were more likely to be boys (adjusted OR: 4.8; 95% CI: 2.5-10.5), display a higher waist circumference (111 ± 12 vs 100 ± 13 cm, p < 0.001) and have metabolic syndrome (adjusted OR: 5.1; 95% CI: 1.6-16.4). Serum ALT predicted hepatic steatosis in boys (AUC: 0.82; 95% CI: 0.70-0.95; p < 0.001) but not girls (AUC = 0.63; 95% CI: 0.46-0.75, p = 0.16). An ALT >20 U/L, combined with the presence of metabolic syndrome, male gender and an elevated waist circumference provided the best model (AUC 0.85) with high sensitivity (72%) and specificity (82%) and positive and negative predictive values of 61% and 89% respectively.
  
  
  CONCLUSIONS
  Serum transaminases provide modest predictive value for hepatic steatosis in youth. The ALT threshold for predicting hepatic steatosis is significantly lower than current clinical thresholds for predicting non-alcoholic fatty liver disease. The addition of ALT, presence of the metabolic syndrome and male gender significant improve the ability to predict hepatic steatosis.
authors.affiliation: Children's Hospital Research Institute of Manitoba, 511 JBRC. 715 McDermot Avenue, Winnipeg, Mb, R3E 3P4, Canada. vsaad@hsc.mb.ca.|The Diabetes Research Group, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, 835 McDermot Avenue, Winnipeg, MB, R3E 0 T8, Canada. vsaad@hsc.mb.ca.
authors.forename: Vera
authors.initials: V
authors.lastname: Saad
authors.affiliation: Children's Hospital Research Institute of Manitoba, 511 JBRC. 715 McDermot Avenue, Winnipeg, Mb, R3E 3P4, Canada. bwicklow@hsc.mb.ca.|Department of Pediatrics and Child Health, Faculty of Health Sciences, College of Medicine University of Manitoba, Manitoba Institute of Child Health, 511 JBRC. 715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada. bwicklow@hsc.mb.ca.|The Diabetes Research Group, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, 835 McDermot Avenue, Winnipeg, MB, R3E 0 T8, Canada. bwicklow@hsc.mb.ca.|Diabetes Research Envisioned and Accomplished in Manitoba Theme, 715 McDermot Avenue, Winnipeg, Mb, R3E 3P4, Canada. bwicklow@hsc.mb.ca.
authors.forename: Brandy
authors.initials: B
authors.lastname: Wicklow
authors.affiliation: Children's Hospital Research Institute of Manitoba, 511 JBRC. 715 McDermot Avenue, Winnipeg, Mb, R3E 3P4, Canada. kwittmeier@hsc.mb.ca.|George and Fay Yee Centre for Healthcare Innovation, 300 Chown Building, 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada. kwittmeier@hsc.mb.ca.|The Diabetes Research Group, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, 835 McDermot Avenue, Winnipeg, MB, R3E 0 T8, Canada. kwittmeier@hsc.mb.ca.|Diabetes Research Envisioned and Accomplished in Manitoba Theme, 715 McDermot Avenue, Winnipeg, Mb, R3E 3P4, Canada. kwittmeier@hsc.mb.ca.
authors.forename: Kristy
authors.initials: K
authors.lastname: Wittmeier
authors.affiliation: Children's Hospital Research Institute of Manitoba, 511 JBRC. 715 McDermot Avenue, Winnipeg, Mb, R3E 3P4, Canada. jhay@chrim.ca.|The Diabetes Research Group, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, 835 McDermot Avenue, Winnipeg, MB, R3E 0 T8, Canada. jhay@chrim.ca.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Hay
authors.affiliation: Children's Hospital Research Institute of Manitoba, 511 JBRC. 715 McDermot Avenue, Winnipeg, Mb, R3E 3P4, Canada. amacintosh@chrim.ca.|The Diabetes Research Group, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, 835 McDermot Avenue, Winnipeg, MB, R3E 0 T8, Canada. amacintosh@chrim.ca.
authors.forename: Andrea
authors.initials: A
authors.lastname: MacIntosh
authors.affiliation: George and Fay Yee Centre for Healthcare Innovation, 300 Chown Building, 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada. niranjan.venugopal@gmail.com.|The Diabetes Research Group, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, 835 McDermot Avenue, Winnipeg, MB, R3E 0 T8, Canada. niranjan.venugopal@gmail.com.
authors.forename: Niranjan
authors.initials: N
authors.lastname: Venugopal
authors.affiliation: George and Fay Yee Centre for Healthcare Innovation, 300 Chown Building, 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada. lryner@cancercare.mb.ca.|The Diabetes Research Group, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, 835 McDermot Avenue, Winnipeg, MB, R3E 0 T8, Canada. lryner@cancercare.mb.ca.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Ryner
authors.affiliation: CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB, R3E 0 V9, Canada. lberard@hsc.mb.ca.|The Diabetes Research Group, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, 835 McDermot Avenue, Winnipeg, MB, R3E 0 T8, Canada. lberard@hsc.mb.ca.
authors.forename: Lori
authors.initials: L
authors.lastname: Berard
authors.affiliation: Children's Hospital Research Institute of Manitoba, 511 JBRC. 715 McDermot Avenue, Winnipeg, Mb, R3E 3P4, Canada. jmcgavock@chrim.ca.|Department of Pediatrics and Child Health, Faculty of Health Sciences, College of Medicine University of Manitoba, Manitoba Institute of Child Health, 511 JBRC. 715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada. jmcgavock@chrim.ca.|The Diabetes Research Group, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, 835 McDermot Avenue, Winnipeg, MB, R3E 0 T8, Canada. jmcgavock@chrim.ca.|Diabetes Research Envisioned and Accomplished in Manitoba Theme, 715 McDermot Avenue, Winnipeg, Mb, R3E 3P4, Canada. jmcgavock@chrim.ca.
authors.forename: Jonathan
authors.initials: J
authors.lastname: McGavock
mesh_terms: D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000175:diagnosis*; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D011237:Predictive Value of Tests; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference; D055815:Young Adult
chemical_list: D015415:Biomarkers; D014280:Triglycerides; D000410:Alanine Transaminase