Evaluation of Hepatitis in Pediatric Patients With Presumed Nonalcoholic Fatty Liver Disease

Fat'hiya Al-Harthy; Neha Kamath; Lee Hill; Jelena Popov; Allison Bossert; Herbert Brill; Nikhil Pai

doi:10.1097/PG9.0000000000000181

Evaluation of Hepatitis in Pediatric Patients With Presumed Nonalcoholic Fatty Liver Disease

JPGN Rep. 2022 Mar 9;3(2):e181. doi: 10.1097/PG9.0000000000000181. eCollection 2022 May.

Authors

Fat'hiya Al-Harthy¹, Neha Kamath², Lee Hill^{3

4}, Jelena Popov^{3

5}, Allison Bossert⁶, Herbert Brill³, Nikhil Pai^{3

7}

Affiliations

¹ From the Department of Pediatrics, Division of Gastroenterology and Nutrition, McMaster University, Hamilton, Canada.
² Faculty of Science, University of Western Ontario, London, Canada.
³ Department of Pediatrics, Division of Gastroenterology and Nutrition, McMaster University, Hamilton, Canada.
⁴ Department of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, ZA.
⁵ College of Medicine and Health, University College Cork, Cork, Republic of Ireland.
⁶ Pediatric Gastroenterology and Nutrition, Hamilton Health Sciences Corporation (McMaster Children's Hospital), Hamilton, Canada.
⁷ Department of Medicine, Farncombe Family Digestive Diseases Research Institute, McMaster University, Hamilton, Canada.

Abstract

In 2017, the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition published clinical practice guidelines for the assessment and diagnosis of nonalcoholic fatty liver disease (NAFLD). We determined how frequently these investigations suggest an alternate etiology for chronic hepatitis in 8- to 17-year-old patients with body mass index >85%, elevated alanine aminotransferase and radiographic steatosis, and rates of adherence to 2017 guidelines.

Methods: We conducted a retrospective chart review of patients presenting to McMaster Children's Hospital from 2017-2020 for evaluation of suspected NAFLD. Bloodwork was reviewed.

Results: Ninety-five patients met inclusion criteria. Abnormal bloodwork that required further testing was found in 28.4%; a different chronic liver disease was ultimately diagnosed in 11.6%. Only 9.5% received comprehensive, additional bloodwork for other causes of liver disease.

Conclusion: A high proportion of patients evaluated for suspected NAFLD had bloodwork possibly suggesting an alternate diagnosis. Comprehensive testing was infrequently performed. These results reinforce the importance of maintaining a differential diagnosis among children presumed to have NAFLD.

Keywords: NAFLD; chronic hepatitis; guidelines; pediatric; testing.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.