OC10 Identifying paediatric non-alcoholic fatty liver disease (NAFLD) in weight management services

• Published in: Frontline gastroenterology 2023-07, Vol.14 (Suppl 1), p.A8-A9
• Main Authors: Whiting, A, Moynihan, S, Chan, J
• Format: Article
• Language: English
• Subjects: Asymptomatic; Body mass index; Children & youth; Comorbidity; Liver diseases; Pediatrics
• ISSN: 2041-4137; 2041-4145
• DOI: 10.1136/flgastro-2023-bspghan.10

12.6% of children in Wales were classified as obese in 2018/19.1 Guidelines advocate for the routine assessment of comorbidity in children with a body mass index (BMI) ≥98th centile.2 Currently available guidelines for comorbidity assessment and subsequent investigation and diagnosis of NAFLD for a population at scale have implications for clinical diagnostics, paediatric phlebotomy and ultrasonography resource.We aim to propose a pathway for implementation within our weight management service, with the intention of initiating future work to devise an all-Wales paediatric NAFLD investigation pathway for children >95th centile BMI.61 asymptomatic children aged between 3–17 years with a BMI ≥98th centile presenting to the tier 3 weight management service between June 2021 and March 2022 were included. The service routinely offers an assessment of comorbidity at referral.3 Retrospective data was obtained from the electronic clinical records of the participants. All children and their families are supported by the service to implement lifestyle modifications.46% of patients were found to have an elevated (>28U/L) alanine transaminase (ALT), which is suggestive of NAFLD. Of those entering the pathway, 10/61 (17%) had raised ALT>60U/L suggesting screening for other causes of liver disease. Of 11 children with raised ALT who went on to receive a liver ultrasound scan, hepatic steatosis was confirmed in 100% of the radiology reports. At 6 months, complete follow-up data was available for 8/29 patients with raised ALT, of which 100% had achieved a reduction in their BMI. Upon retesting, ALT normalised in 50% (4/8) of these patients and no patient exhibited a rise in their ALT.The scale of population of asymptomatic children requiring assessment for NAFLD has emerged from this data. There appears a need for urgent revision of guidelines to produce a safe and sustainable pathway. We propose the following pathway (figure 1) which aims to detect those in whom alternative underlying diagnoses might exist.Abstract OC10 Figure 1 Hobson G, Rosalind R, May L, et al. Child measurement programme, 2021. (Accessed Jan 5, 2023, at https://phw.nhs.wales/services-and-teams/child-measurement-programme/cmp-2018-19/child-measurement-programme-for-wales-report-2018-19/.) Welsh Government. All Wales weight management pathway, 2021. (Accessed Jan 5, 2023, at https://www.gov.wales/sites/default/files/publications/2021-06/all-wales-weight-management-pathway-2021-children-young-people-and-