title: What is the appropriate strategy for diagnosing NAFLD using ultrasonography in obese children?
abstract: BACKGROUND
  The aim of this study is to identify obese children who are candidates for a potential diagnosis of non-alcoholic fatty liver disease (NAFLD).
  
  
  METHODS
  We enrolled 242 obese children (122 boys and 120 girls) aged 7-16 years who were examined with abdominal ultrasonography in our pediatric obesity clinic. We compared patients in the normal group with those in the NAFLD group (mild disease, moderate to severe disease) and identified the optimal anthropometric parameters among height, weight, body mass index (BMI), waist circumference, hip circumference, waist to height ratio (WHtR), and waist to hip ratio to predict NAFLD using a receiver operating characteristic curve analysis. We also investigated risk factors associated with NAFLD for the anthropometric parameters and the biochemical model using logistic regression.
  
  
  RESULTS
  The high- and low-risk groups for hepatic steatosis relative to a WHtR of 0.56 as the standard point showed significant differences in hepatic steatosis severity grade (P<0.001), BMI (P=0.004), hip circumference (P=0.090), aspartate aminotransferase (P<0.001), alanine aminotransferase (P<0.001), triglycerides (P=0.001), and the triglyceride to high-density lipoprotein (HDL) cholesterol ratio (P=0.006). Risk factors for hepatic steatosis on logistic regression analysis were male sex (odds ratio: 3.68, 95% confidence interval: 1.76-7.70), WHtR >0.56 (2.25, 1.05-4.81), and waist circumference >90th percentile (20.22, 9.21-44.36) in the anthropometric parameter model and elevated alanine aminotransferase levels (boys >25.8 U/L, girls >22.1 U/L) (6.93, 2.52-19.03), hypertriglyceridemia (>110 mg/dL) (3.80, 1.23-11.75), and triglyceride to HDL cholesterol ratio >3 (9.23, 2.95-8.83) in the biochemical parameter model.
  
  
  CONCLUSIONS
  A diagnostic approach to hepatic steatosis is recommended as part of the proper screening and stratification of risk factors in obese children. WHtR is a simple and convenient method of effectively identifying obese children who are candidates for hepatic steatosis screening.
authors.affiliation: Department of Pediatrics, Ansan Hospital, Korea University Medical Center, College of Medicine, Korea University, Seoul, Korea.
authors.forename: Jee Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Gyeonggi-do, Korea. jinped@cha.ac.kr.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Jeong
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D002648:Child; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging*; D063766:Pediatric Obesity; D012307:Risk Factors; D014463:Ultrasonography / Q000379:methods*
keywords: hepatic steatosis; non-alcoholic fatty liver disease; obesity; waist-to-height ratio