{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T09:57:09Z","timestamp":1753869429708,"version":"3.41.2"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,12,23]],"date-time":"2023-12-23T00:00:00Z","timestamp":1703289600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>Pediatric non\u2010alcoholic fatty liver disease (NAFLD) is a progressive disorder that is increasing in incidence globally. The study aims to describe the clinical profile and longitudinal outcome, including the utility of vibration\u2010controlled transient elastography (VCTE), in children with NAFLD at a single tertiary liver unit in Singapore.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective review of patients aged 0\u201318\u2009years referred for NAFLD from 2003 to 2020 was conducted. Diagnosis was based on persistent elevation of alanine transaminase \u22652\u00d7 the upper limit of normal in at\u2010risk patients, and\/or radiologic detection of hepatic steatosis, with the exclusion of other etiologies. VCTE\u2010derived liver stiffness measurements (LSMs) \u22647.0\u2009, 7.1\u20139.0, and \u22659.1\u2009kPa were used to differentiate normal (F0\u2013F1), significant fibrosis (F2), and advanced fibrosis (F3\u2013F4), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study included 210 patients (72.4% male, mean age 11.6\u2009years). New cases increased from 1.7\/1000 referrals in 2003\u20132008 to 12.7 and 24.5\/1000 referrals in 2009\u20132014 and 2015\u20132020, respectively. Significant proportion had dyslipidemia (41.4%), impaired glucose tolerance\/diabetes (IGT\/DM, 26.7%), and hypertension (17.1%). Only 6.2% had resolution of NAFLD after a mean follow\u2010up of 3.7\u2009years. Based on VCTE (<jats:italic>n<\/jats:italic>\u2009=\u200965), 41.5% had normal LSM, while 26.2% and 32.3% had increased likelihood of significant and advanced fibrosis, respectively. Age \u226516\u2009years (odds ratio [OR] 8.9), IGT\/DM (OR 6.5), and aspartate transaminase &gt;70\u2009U\/L (OR 11.0) were independent risk factors associated with increased likelihood of advanced fibrosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Incidence of pediatric NAFLD has increased dramatically in Singapore. Based on LSM estimation, pediatric NAFLD may be associated with an increased risk of developing advanced fibrosis by late adolescence.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jgh3.13020","type":"journal-article","created":{"date-parts":[[2023,12,23]],"date-time":"2023-12-23T15:02:21Z","timestamp":1703343741000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical profile, referral trends, and real\u2010world application of vibration\u2010controlled transient elastography in children with non\u2010alcoholic fatty liver disease in Singapore"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4777-0267","authenticated-orcid":false,"given":"Fang Kuan","family":"Chiou","sequence":"first","affiliation":[{"name":"Gastroenterology, Hepatology &amp; Nutrition Service, Paediatric Medicine KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynette","family":"Goh","sequence":"additional","affiliation":[{"name":"Gastroenterology, Hepatology &amp; Nutrition Service, Paediatric Medicine KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8463-8447","authenticated-orcid":false,"given":"Christopher Wen Wei","family":"Ho","sequence":"additional","affiliation":[{"name":"Gastroenterology, Hepatology &amp; Nutrition Service, Paediatric Medicine KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charanya","family":"Rajan","sequence":"additional","affiliation":[{"name":"Gastroenterology, Hepatology &amp; Nutrition Service, Paediatric Medicine KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veena","family":"Logarajah","sequence":"additional","affiliation":[{"name":"Gastroenterology, Hepatology &amp; Nutrition Service, Paediatric Medicine KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lay Queen","family":"Ng","sequence":"additional","affiliation":[{"name":"Gastroenterology, Hepatology &amp; Nutrition Service, Paediatric Medicine KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kong Boo","family":"Phua","sequence":"additional","affiliation":[{"name":"Gastroenterology, Hepatology &amp; Nutrition Service, Paediatric Medicine KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,12,23]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2017.109"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-0771"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/20469047.2020.1747002"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2008.171280"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2020.07.034"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000001482"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2015.12.016"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/cld.636"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-060640"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc22-S002"},{"key":"e_1_2_7_12_1","unstructured":"Ministry of Health Singapore.Ministry of health clinical practice guidelines on lipids. 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