Clinical profile, referral trends, and real‐world application of vibration‐controlled transient elastography in children with non‐alcoholic fatty liver disease in Singapore
Abstract 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), i...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-01-01
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| Series: | JGH Open |
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| Online Access: | https://doi.org/10.1002/jgh3.13020 |
| _version_ | 1797321301561442304 |
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| author | Fang Kuan Chiou Lynette Goh Christopher Wen Wei Ho Charanya Rajan Veena Logarajah Lay Queen Ng Kong Boo Phua |
| author_facet | Fang Kuan Chiou Lynette Goh Christopher Wen Wei Ho Charanya Rajan Veena Logarajah Lay Queen Ng Kong Boo Phua |
| author_sort | Fang Kuan Chiou |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-03-08T04:56:36Z |
| format | Article |
| id | doaj.art-86827aa66ba74a9aa7e237ad2cc62d7a |
| institution | Directory Open Access Journal |
| issn | 2397-9070 |
| language | English |
| last_indexed | 2024-03-08T04:56:36Z |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | JGH Open |
| spelling | doaj.art-86827aa66ba74a9aa7e237ad2cc62d7a2024-02-07T15:12:06ZengWileyJGH Open2397-90702024-01-0181n/an/a10.1002/jgh3.13020Clinical profile, referral trends, and real‐world application of vibration‐controlled transient elastography in children with non‐alcoholic fatty liver disease in SingaporeFang Kuan Chiou0Lynette Goh1Christopher Wen Wei Ho2Charanya Rajan3Veena Logarajah4Lay Queen Ng5Kong Boo Phua6Gastroenterology, Hepatology & Nutrition Service, Paediatric Medicine KK Women's and Children's Hospital Singapore SingaporeGastroenterology, Hepatology & Nutrition Service, Paediatric Medicine KK Women's and Children's Hospital Singapore SingaporeGastroenterology, Hepatology & Nutrition Service, Paediatric Medicine KK Women's and Children's Hospital Singapore SingaporeGastroenterology, Hepatology & Nutrition Service, Paediatric Medicine KK Women's and Children's Hospital Singapore SingaporeGastroenterology, Hepatology & Nutrition Service, Paediatric Medicine KK Women's and Children's Hospital Singapore SingaporeGastroenterology, Hepatology & Nutrition Service, Paediatric Medicine KK Women's and Children's Hospital Singapore SingaporeGastroenterology, Hepatology & Nutrition Service, Paediatric Medicine KK Women's and Children's Hospital Singapore SingaporeAbstract 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.https://doi.org/10.1002/jgh3.13020elastographyfibrosisnon‐alcoholic fatty liver diseasepediatrics |
| spellingShingle | Fang Kuan Chiou Lynette Goh Christopher Wen Wei Ho Charanya Rajan Veena Logarajah Lay Queen Ng Kong Boo Phua Clinical profile, referral trends, and real‐world application of vibration‐controlled transient elastography in children with non‐alcoholic fatty liver disease in Singapore JGH Open elastography fibrosis non‐alcoholic fatty liver disease pediatrics |
| title | Clinical profile, referral trends, and real‐world application of vibration‐controlled transient elastography in children with non‐alcoholic fatty liver disease in Singapore |
| title_full | Clinical profile, referral trends, and real‐world application of vibration‐controlled transient elastography in children with non‐alcoholic fatty liver disease in Singapore |
| title_fullStr | Clinical profile, referral trends, and real‐world application of vibration‐controlled transient elastography in children with non‐alcoholic fatty liver disease in Singapore |
| title_full_unstemmed | Clinical profile, referral trends, and real‐world application of vibration‐controlled transient elastography in children with non‐alcoholic fatty liver disease in Singapore |
| title_short | Clinical profile, referral trends, and real‐world application of vibration‐controlled transient elastography in children with non‐alcoholic fatty liver disease in Singapore |
| title_sort | clinical profile referral trends and real world application of vibration controlled transient elastography in children with non alcoholic fatty liver disease in singapore |
| topic | elastography fibrosis non‐alcoholic fatty liver disease pediatrics |
| url | https://doi.org/10.1002/jgh3.13020 |
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