https://pubmed.ncbi.nlm.nih.gov/38388968/ NAFLD

World J Pediatr. 2024 Feb 22.
doi: 10.1007/s12519-023-00789-5. Online ahead of print.

Continuous age- and sex-specific reference ranges of liver enzymes in Chinese children and application in pediatric non-alcoholic fatty liver disease

Zhao-Yuan Wu 1, Si-Wei Chi 1, Liu-Jian Ouyang 1, Xiao-Qin Xu 1, Jing-Nan Chen 1, Bing-Han Jin 1, Rahim Ullah 1, Xue-Lian Zhou 1, Ke Huang 1, Guan-Ping Dong 1, Zhe-Ming Li 2, Ying Shen 3, Jie Shao 3, Yan Ni 1, Jun-Fen Fu 4, Qiang Shu 5, Wei Wu 6

Abstract
Background: Alanine aminotransferase (ALT) is widely used to screen patients with hepatic diseases. However, the current reference ranges (< 50 U/L) were developed by laboratories and have not been validated in populations with a large number of healthy individuals.

Methods: This study collected venous blood and anthropometric data from a total of 13,287 healthy children aged 3 months to 18 years who underwent routine physical examinations in the Department of Pediatric Healthcare. We applied the least mean square algorithm to establish age- and sex-related reference percentiles of serum levels of transaminases. For validation, we recruited 4276 children and adolescents with obesity/overweight who underwent evaluation and metabolic tests in the hospital. Using receiver operating characteristic curves, we determined age- and sex-specific upper limit percentiles of liver enzymes for fatty liver diseases.

Results: This study revealed a significant correlation between serum transaminase levels and age and sex (P < 0.01). These transaminase levels exhibited age- and sex-specific patterns. Among individuals in the non-alcoholic fatty liver disease (NAFLD) cohort, elevated ALT levels displayed a positive association with clinical markers of disease severity, including homeostatic model assessment of insulin resistance, waist-hip ratio, and serum uric acid levels (P < 0.01). According to the receiver operating characteristic curves, ALT levels at the 92.58th percentile for boys and the 92.07th percentile for girls yielded the highest accuracy and specificity.
Conclusions: This study provides age- and sex-specific reference ranges for ALT, aspartate aminotransferase, and γ-glutamyltransferase in Chinese children and adolescents, making it the largest population study to date. Furthermore, the study establishes a precise upper limit for ALT levels, facilitating their use in NAFLD screening. Video Abstract.