Prevalence and Correlates of Suspected Nonalcoholic Fatty Liver Disease in Chinese American Children

Goals: The aim of this study was to evaluate the prevalence and clinical correlates of nonalcoholic fatty liver disease (NAFLD) in children of Chinese immigrants. Background: NAFLD is increasing in prevalence and is frequently identified in children. High rates of NAFLD were found in adult Chinese immigrants. However, there are limited data regarding NAFLD in Chinese American children. Study: Clinical and laboratory data were collected from 407 children, aged 6 to 18 years, who had routine office visits at a China-town medical practice. Children were classified as having suspected NAFLD if common causes of liver disease were excluded, alanine aminotransferase levels exceeded established thresholds (>22.1 IU/L for girls and >25.8 IU/L for boys), and elevated alanine aminotransferase levels were confirmed by repeat measurement. Results: 6.1% of Chinese American children had suspected NAFLD, including 33% of obese children. Seventeen percent of children were overweight, 14% were obese, and 52% had 25-hydroxy vitamin D levels <20 ng/mL. In univariable analysis, children with suspected NAFLD were more frequently male, had higher body mass index percentile and lipid levels, and lower vitamin D levels compared with children without evidence of NAFLD. In multivariable analysis, suspected NAFLD was associated with higher BMI percentile and lower vitamin D levels when adjusting for other factors. Conclusions: Chinese American children with obesity are at high risk for NAFLD. They should be screened accordingly, including testing for metabolic disorders and low vitamin D levels. Early identification of NAFLD in childhood will allow for intervention with lifestyle modification, providing a means to reduce the prevalence of NAFLD in children and adults.