Predictors of non-alcoholic liver disease in ethnically diverse overweight children and adolescents

Objectives: To study the relationship between Non-Alcoholic Fatty Liver Disease (NAFLD) and sleep, Physical Activity (PA), and screen-time habits/behaviors among a multiethnic sample of overweight children/adolescents. Methods: A retrospective medical chart review (6/2013-7/2014) identified 209 patients (7-21 years old) who were overweight/obese (BMI > 85^th % for age/sex). A follow-up telephone survey was completed among 130 of these patients' parents to obtain information on sleep, screen-time, PA habits, and socio-demographics. NAFLD was defined as ALT and/or AST levels above the age/sex-adjusted cutoff value in the absence of medications or associated medical conditions. Logistic regression models were fitted to identify predictors of NAFLD by adjusting age, sex, heritage, and income. Results: Over a third (34%) of the sample (N=130, 55% males, 74% Hispanic) had NAFLD. Compared to non-Hispanics, Central American heritage subjects were over three times as likely to have NAFLD compared to non-Hispanics (OR=3.90, 95% CI, 1.23-12.37) after adjusting for socio-economics and lifestyle habits. Subjects with low PA levels were at increased risk for NAFLD (aOR=4.52, 95% CI, 1.21-16.82) compared to their more active counterparts. Lower income families were over twice as likely to have NAFLD as higher income families (OR = 2.57, 0.95-6.96). Conclusions: Families residing from a Central American heritage are at significant risk for NAFLD versus their ethnic group counterparts. Identifying specific groups and risks for pediatric-onset NAFLD can inform and improve clinical practice and public health initiatives, especially as patient populations become more ethnically diverse across the nation.