ABSTRACT
OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) is a common cause of pediatric liver disease. Studies suggest decreased prevalence in blacks, females, and younger children. However, the proportion of black subjects in these studies was small, and children under 12 were not included. We propose that abnormal alanine aminotransferase (ALT) is more common in whites than blacks, males than females, and children over 12 compared with younger children in a prospective study. METHODS: We enrolled 181 consecutive asymptomatic obese children attending general pediatric clinics who denied recent fever or known liver disease. Obesity was defined as body mass index (BMI) z score of greater than 1.64 (95th percentile for age and sex). Elevated ALT was defined as greater than 40 U/L. BMI z score, race, sex, age, and parental obesity were compared using the chi-square test and Fisher's exact test. RESULTS: The population included 81 males and 100 females, 147 non-Hispanic black, 33 non-Hispanic white, and 1 Hispanic white. Elevated ALT occurred in 14 (8%) subjects. White children were significantly more likely to have abnormal ALT (odds ratio [OR] = 4.0, P < .02). Very obese children (BMI z score >2.3) were more likely to have abnormal ALT compared with mildly obese children (OR = 4.0, P < 0.05). Sex, age, hepatomegaly, acanthosis nigricans, and parental obesity did not significantly predict elevated ALT. CONCLUSION: Eight percent of asymptomatic, obese children had an elevated ALT suggestive of NAFLD. White and very obese children are more likely to be affected. Sex and age are not good clinical predictors of NAFLD. We suggest that all obese children be screened for NAFLD.
Subject(s)
Black or African American , Fatty Liver/epidemiology , Liver/enzymology , Obesity/complications , White People , Adolescent , Age Factors , Alanine Transaminase/metabolism , Body Mass Index , Child , Child, Preschool , Fatty Liver/enzymology , Fatty Liver/etiology , Female , Humans , Male , Prevalence , Prospective Studies , Sex FactorsABSTRACT
Obesity in children is a rapidly growing problem and may be underrecognized by pediatricians. We reviewed 473 consecutive well child visits to assess frequency of correctly identifying overweight children. Of children with a body mass index greater than the 95th percentile for gender and age, only 27 (29%) were diagnosed as overweight by the physician. Our results suggest that the frequency of diagnosing children as overweight at well child visits is critically low.
Subject(s)
Obesity/diagnosis , Adolescent , Body Mass Index , Child , Child Health Services , Child, Preschool , Female , Humans , Logistic Models , Male , Obesity/therapy , Retrospective StudiesABSTRACT
PURPOSE: To determine the risk factors and clinical presentation of primary omental torsion (POT) in children. METHODS: Histopathology records of a pediatric hospital from January 1993 to March 2003 were reviewed to identify cases of POT. Hospital charts of patients diagnosed with POT were reviewed for demographic data and clinical presentation. RESULTS: A diagnosis of POT was recorded in 12 of 41,987 pathology records reviewed. Most of the patients were white (92%), male (75%), and 9 to 16 years old (75%). Weight percentiles were >or=95th in 11 (92%) of 12 patients. Body mass index was calculated in 9 of the 12 cases with 8 >95th percentile. Clinical presentation including right-sided abdominal pain, tenderness, and anorexia closely mimics acute appendicitis. CONCLUSIONS: Obesity seems to be an important risk factor for POT in children. The presentation for POT seems to be less acute than with other causes of surgical abdomen.
Subject(s)
Obesity/complications , Omentum , Peritoneal Diseases/etiology , Abdominal Pain/etiology , Adolescent , Child , Female , Humans , Male , Peritoneal Diseases/diagnosis , Retrospective Studies , Risk Factors , Torsion AbnormalityABSTRACT
The objective of this prospective study was to determine the impact of early literacy anticipatory guidance (AG) with provision of books on language development in 3-year-olds in an early literacy program at a University-affiliated inner-city pediatric clinic. The Peabody Picture Vocabulary Test (PPVT-III) and the Expressive One Word Picture Vocabulary Test (EOWPVT-R) were administered to 33-39-month-old children exposed to an early literacy program, which included AG and provision of an age-appropriate book at each well-child visit starting at 2 months old. Children with developmental delays were excluded. Parental surveys on literacy and demographic data were obtained. Univariate and multivariate analyses were performed. Sixty-four children were evaluated; 88% African American, 89% Medicaid recipients. Fifty-eight percent of families reported family-centered literacy orientation. The PPVT-III scores directly correlated with the number of AG visits with book given x number of books purchased (r2 = 0.025, p = 0.0006). Higher scores in EOWPVT-R were predicted by race and the number of visits with books given x number of books purchased (r2 = 0.182, p = 0.0009). All families reported reading together, half reporting positive family-centered literacy. Given the same number of books purchased for each child, the outcome scores were higher the greater the number of clinic visits wherein AG included early literacy and provision of books.
