Alanine aminotransferase as a monitoring biomarker in children with nonalcoholic fatty liver disease: A secondary analysis using tonic trial data

Idil Arsik, Jennifer K. Frediani, Damon Frezza, Wen Chen, Turgay Ayer, Pinar Keskinocak, Ran Jin, Juna V. Konomi, Sarah E. Barlow, Stavra A. Xanthakos, Joel E. Lavine, Miriam B. Vos

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Background: Validated noninvasive biomarkers to assess treatment response in pediatric nonalcoholic fatty liver disease (NAFLD) are lacking. We aimed to validate alanine aminotransferase (ALT), a monitoring biomarker for change in liver histology. Methods: A retrospective analysis using data from the TONIC trial. NAFLD histologic assessments were defined by: Fibrosis score, NAFLD activity score (NAS), nonalcoholic steatohepatitis (NASH), and a combination of NASH resolution and fibrosis (NASH + fibrosis). Analysis was performed using classification and regression trees (CART) as well as logistic regression. Results: Mean ALT for the child over 96 weeks and percent change of ALT from baseline to 96 weeks were significant predictors of progression of NAFLD for each histologic assessment (p < 0.001 for fibrosis score, NASH, and NASH + fibrosis and p < 0.05 for NAS). Mean ALT adjusted for age, sex and ethnicity was a better predictor for change in NASH (81.8 (11.0) ROC (receiver operating characteristic curve) mean (SD (Standard derivation))) and NASH + fibrosis (77.8 (11.2)), compared to change in NAS (63 (17.7)) and fibrosis (58.6 (11.1)). Conclusion: Mean ALT over 96 weeks is a reasonable proxy of histologic improvement of NASH and NASH + fibrosis. These findings support ALT as a valid monitoring biomarker of histologic change over time in children with NASH and fibrosis.

Original languageEnglish (US)
Article number64
JournalChildren
Volume5
Issue number6
DOIs
StatePublished - Jun 2018

Keywords

  • ALT
  • Fibrosis
  • NASH
  • Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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