The following is a summary of “Prevalence of Elevated ALT in Adolescents in the US 2011–2018,” published in the July 2023 issue of the Pediatric Gastroenterology and Nutrition by Mischel et al.

This study aims to characterize suspected nonalcoholic fatty liver disease (NAFLD) by assessing elevated alanine aminotransferase (ALT) levels in a diverse and nationally representative group of adolescents. Additionally, the study aims to characterize the occurrence of higher ALT elevation in adolescents with obesity. Data from the National Health and Nutrition Examination Survey 2011–2018 were examined for adolescents aged 12–19. Participants with etiologies for elevated alanine aminotransferase (ALT) levels other than non-alcoholic fatty liver disease (NAFLD) were excluded. The study investigated the impact of race and ethnicity, sex, body mass index (BMI), and alanine aminotransferase (ALT) levels. Elevated alanine aminotransferase (ALT) levels were above the biologically determined upper standard limit (ULN) of >22 U/L for females and >26 U/L for males. 

Elevated alanine aminotransferase (ALT) thresholds up to two times the upper limit of normal (2X-ULN) were assessed in adolescents presenting with obesity. Multivariable logistic regression analysis was employed to ascertain the correlation between race/ethnicity and elevated alanine aminotransferase (ALT) levels while accounting for age, sex, and body mass index (BMI). Elevated alanine aminotransferase (ALT) in adolescents was 16.5%, with a higher prevalence of 39.5% observed among those diagnosed with obesity. The prevalence rates among White, Hispanic, and Asian adolescents were 15.8%, 21.8%, and 16.5% in the general population, 12.8%, 17.7%, and 27.0% among those classified as overweight, and 43.0%, 43.5%, and 43.1% among those classified as obese, respectively. The condition’s prevalence was significantly lower among Black adolescents, with an overall rate of 10.7%. 

Among those who were overweight, the prevalence was 8.4%, while among those who were obese, the majority was 20.7%. The majority of alanine aminotransferase (ALT) levels at two times the upper limit of normal (ULN) was found to be 6.6% in adolescents diagnosed with obesity. Hispanic ethnicity, advanced age, male gender, and higher body mass index (BMI) were identified as separate factors that independently predicted elevated alanine aminotransferase (ALT) levels. The prevalence of elevated alanine aminotransferase (ALT) levels in adolescents in the United States is significant, impacting approximately 1 in 6 adolescents between 2011 and 2018. The risk is most pronounced in Hispanic adolescents. Asian adolescents with elevated body mass index (BMI) may present as an emerging risk group for elevated alanine aminotransferase (ALT) levels.

Source: journals.lww.com/jpgn/Abstract/2023/07000/Prevalence_of_Elevated_ALT_in_Adolescents_in_the.16.aspx