title: The Prevalence of Non-Alcoholic Fatty Liver Disease in Children and Adolescents: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  Narrative reviews of paediatric NAFLD quote prevalences in the general population that range from 9% to 37%; however, no systematic review of the prevalence of NAFLD in children/adolescents has been conducted. We aimed to estimate prevalence of non-alcoholic fatty liver disease (NAFLD) in young people and to determine whether this varies by BMI category, gender, age, diagnostic method, geographical region and study sample size.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of all studies reporting a prevalence of NAFLD based on any diagnostic method in participants 1-19 years old, regardless of whether assessing NAFLD prevalence was the main aim of the study.
  
  
  RESULTS
  The pooled mean prevalence of NAFLD in children from general population studies was 7.6% (95%CI: 5.5% to 10.3%) and 34.2% (95% CI: 27.8% to 41.2%) in studies based on child obesity clinics. In both populations there was marked heterogeneity between studies (I2 = 98%). There was evidence that prevalence was generally higher in males compared with females and increased incrementally with greater BMI. There was evidence for differences between regions in clinical population studies, with estimated prevalence being highest in Asia. There was no evidence that prevalence changed over time. Prevalence estimates in studies of children/adolescents attending obesity clinics and in obese children/adolescents from the general population were substantially lower when elevated alanine aminotransferase (ALT) was used to assess NAFLD compared with biopsies, ultrasound scan (USS) or magnetic resonance imaging (MRI).
  
  
  CONCLUSIONS
  Our review suggests the prevalence of NAFLD in young people is high, particularly in those who are obese and in males.
authors.affiliation: MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom; School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Emma L
authors.initials: EL
authors.lastname: Anderson
authors.affiliation: MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom; School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Howe
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Hayley E
authors.initials: HE
authors.lastname: Jones
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Centre for Reviews and Dissemination, University of York, York, United Kingdom.
authors.forename: Julian P T
authors.initials: JP
authors.lastname: Higgins
authors.affiliation: MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom; School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Debbie A
authors.initials: DA
authors.lastname: Lawlor
authors.affiliation: MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom; School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Abigail
authors.initials: A
authors.lastname: Fraser
mesh_terms: D000293:Adolescent; D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000453:epidemiology*; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers