Incidence of Nonalcoholic Fatty Liver Disease in Children: 2009-2018
Incidence of Nonalcoholic Fatty Liver Disease in Children: 2009-2018
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DOI：
10.1542/peds.2020-0771
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发表时间：
2020-12-01
期刊：
影响因子：
8
通讯作者：
Schwimmer, Jeffrey B.
中科院分区：
文献类型：
--
作者：
Sahota, Amandeep K.;Shapiro, Warren L.;Schwimmer, Jeffrey B.
背景和目的：2007年，美国儿科学会建议肥胖儿童应接受非酒精性脂肪肝（NAFLD）筛查。人群流行病学表明，NAFLD在儿童中很常见;然而，对临床诊断率知之甚少。在这项研究中，我们的目的是确定在一个综合社区卫生系统中儿童NAFLD的筛查实践，年发病率和临床特征。方法：使用电子健康记录，我们根据国际疾病分类第9版和第10版的诊断代码确定了新诊断的NAFLD患者（5-18岁）。我们计算了2009年1月1日至2018年12月31日期间NAFLD的筛查率和年发病率。结果：在本研究中，我们评估了7 884 844患者年。在54.0%的肥胖儿童和24.0%的超重儿童中进行了筛查。结果显示，36658名9 ~ 18岁超重或肥胖儿童丙氨酸氨基转移酶>30 U/L。在这些儿童中，12.3%接受了NAFLD的进一步检查。NAFLD诊断的发生率随着时间的推移显著增加，2009年为每10万人36.0例，2018年为每10万人58.2例（P < .0001）。结论：我们对加州南部一个大型综合医疗保健系统的研究显示，儿童NAFLD的发病率正在增加，尽管许多儿童可能仍未确诊。在一个健康维护组织中，NAFLD的发病率增加，并与2型糖尿病、高血压和血脂异常的高发病率相关。
BACKGROUND AND OBJECTIVES: In 2007, the American Academy of Pediatrics recommended that children with obesity should be screened for nonalcoholic fatty liver disease (NAFLD). Population epidemiology reveals that NAFLD is common in children; however, little is known about rates of clinical diagnosis. In this study, we aim to determine screening practices, annual incidence, and clinical characteristics of NAFLD in children within an integrated community health system. METHODS: Using electronic health records, we identified patients newly diagnosed (aged 5-18) with NAFLD on the basis of diagnostic codes from the 9th and 10th revisions of the International Classification of Diseases. We calculated screening rates and annual incidence rates of NAFLD from January 1, 2009, to December 31, 2018. RESULTS: In this study, we evaluated 7 884 844 patient-years. Screening was performed in 54.0% of children with obesity and 24.0% of children with overweight. The results revealed 36 658 children aged 9 to 18 with overweight or obesity and alanine aminotransferase >30 U/L. Of these children, 12.3% received further workup for NAFLD. The incidence of an NAFLD diagnosis significantly increased over time, with 36.0 per 100 000 in 2009 and 58.2 per 100 000 in 2018 (P < .0001). CONCLUSIONS: Our study of a large integrated health care system in southern California revealed that the incidence of NAFLD in children is increasing, although many children may remain undiagnosed.Across a health maintenance organization, NAFLD increased in incidence and was associated with high rates of type 2 diabetes, hypertension, and dyslipidemia.