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

• Published in: World journal of pediatrics : WJP Vol. 20; no. 9; pp. 949 - 956
• Main Authors: Wu, Zhao-Yuan, Chi, Si-Wei, Ouyang, Liu-Jian, Xu, Xiao-Qin, Chen, Jing-Nan, Jin, Bing-Han, Ullah, Rahim, Zhou, Xue-Lian, Huang, Ke, Dong, Guan-Ping, Li, Zhe-Ming, Shen, Ying, Shao, Jie, Ni, Yan, Fu, Jun-Fen, Shu, Qiang, Wu, Wei
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.09.2024
• Subjects: Adolescent; Age Factors; Alanine Transaminase - blood; Aspartate Aminotransferases - blood; Child; Child, Preschool; China; Critical Care Medicine; East Asian People; Female; Humans; Imaging; Infant; Intensive; Liver Function Tests; Male; Maternal and Child Health; Medicine; Medicine & Public Health; Non-alcoholic Fatty Liver Disease - blood; Non-alcoholic Fatty Liver Disease - diagnosis; Original Article; Pediatric Surgery; Pediatrics; Radiology; Reference Values; ROC Curve; Sex Factors; Surgery; China; Alanine aminotransferase; Fatty liver diseases; Childhood
• ISSN: 1708-8569; 1867-0687
• DOI: 10.1007/s12519-023-00789-5

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. CoEzBqA-ybMqMjKK3XNXmu Video Abstract