Clinical profile, referral trends, and real‐world application of vibration‐controlled transient elastography in children with non‐alcoholic fatty liver disease in Singapore

• Published in: JGH open 2024-01, Vol.8 (1), p.e13020-n/a
• Main Authors: Chiou, Fang Kuan, Goh, Lynette, Ho, Christopher Wen Wei, Rajan, Charanya, Logarajah, Veena, Ng, Lay Queen, Phua, Kong Boo
• Format: Article
• Language: English
• Subjects: Biochemistry; Biopsy; Body mass index; Cardiovascular disease; Comorbidity; Demographics; Diabetes; elastography; Epilepsy; Family medical history; fibrosis; Gastroesophageal reflux; Genotype & phenotype; Glucose; Histology; Hypertension; Laboratories; Liver cirrhosis; Liver diseases; Metabolic disorders; non‐alcoholic fatty liver disease; Obesity; Original; Overweight; Patients; Pediatrics; Sleep apnea; Standard scores; Trends
• ISSN: 2397-9070; 2397-9070
• DOI: 10.1002/jgh3.13020

Background and Aim Pediatric non‐alcoholic fatty liver disease (NAFLD) is a progressive disorder that is increasing in incidence globally. The study aims to describe the clinical profile and longitudinal outcome, including the utility of vibration‐controlled transient elastography (VCTE), in children with NAFLD at a single tertiary liver unit in Singapore. Methods Retrospective review of patients aged 0–18 years referred for NAFLD from 2003 to 2020 was conducted. Diagnosis was based on persistent elevation of alanine transaminase ≥2× the upper limit of normal in at‐risk patients, and/or radiologic detection of hepatic steatosis, with the exclusion of other etiologies. VCTE‐derived liver stiffness measurements (LSMs) ≤7.0 , 7.1–9.0, and ≥9.1 kPa were used to differentiate normal (F0–F1), significant fibrosis (F2), and advanced fibrosis (F3–F4), respectively. Results The study included 210 patients (72.4% male, mean age 11.6 years). New cases increased from 1.7/1000 referrals in 2003–2008 to 12.7 and 24.5/1000 referrals in 2009–2014 and 2015–2020, respectively. Significant proportion had dyslipidemia (41.4%), impaired glucose tolerance/diabetes (IGT/DM, 26.7%), and hypertension (17.1%). Only 6.2% had resolution of NAFLD after a mean follow‐up of 3.7 years. Based on VCTE (n = 65), 41.5% had normal LSM, while 26.2% and 32.3% had increased likelihood of significant and advanced fibrosis, respectively. Age ≥16 years (odds ratio [OR] 8.9), IGT/DM (OR 6.5), and aspartate transaminase >70 U/L (OR 11.0) were independent risk factors associated with increased likelihood of advanced fibrosis. Conclusion Incidence of pediatric NAFLD has increased dramatically in Singapore. Based on LSM estimation, pediatric NAFLD may be associated with an increased risk of developing advanced fibrosis by late adolescence. Incidence of pediatric NAFLD in Singapore has increased more than 10‐fold, from 1.7 new cases per 1000 referrals in 2003–2008, to 12.7 per 1000 referrals in 2009–2014, and 24.5 per 1000 referrals in 2015–2020, out of a total of 14193 new outpatient referrals seen at our unit over the 18‐year period.