{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T11:56:19Z","timestamp":1791633379324,"version":"4.3.4"},"reference-count":41,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2013,10,1]],"date-time":"2013-10-01T00:00:00Z","timestamp":1380585600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/"}],"funder":[{"DOI":"10.13039\/100000097","name":"NCRR","doi-asserted-by":"crossref","award":["UL1RR031980"],"award-info":[{"award-number":["UL1RR031980"]}],"id":[{"id":"10.13039\/100000097","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100007911","name":"UCSD","doi-asserted-by":"crossref","award":["DK088925-02S1"],"award-info":[{"award-number":["DK088925-02S1"]}],"id":[{"id":"10.13039\/100007911","id-type":"DOI","asserted-by":"crossref"}]},{"name":"NSF","award":["#414916"],"award-info":[{"award-number":["#414916"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Screening overweight and obese children for non\u2010alcoholic fatty liver disease (<jats:styled-content style=\"fixed-case\">NAFLD<\/jats:styled-content>) is recommended by paediatric and endocrinology societies. However, gastroenterology societies have called for more data before making a formal recommendation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To determine whether the detection of suspected <jats:styled-content style=\"fixed-case\">NAFLD<\/jats:styled-content> in overweight and obese children through screening in primary care and referral to paediatric gastroenterology resulted in a correct diagnosis of <jats:styled-content style=\"fixed-case\">NAFLD<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Information generated in the clinical evaluation of 347 children identified with suspected <jats:styled-content style=\"fixed-case\">NAFLD<\/jats:styled-content> through screening in primary care and referral to paediatric gastroenterology was captured prospectively. Diagnostic outcomes were reported. The diagnostic performance of two times the upper limit of normal (ULN) for alanine aminotransferase (<jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content>) was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Non\u2010alcoholic fatty liver disease was diagnosed in 55% of children identified by screening and referral. Liver disease other than <jats:styled-content style=\"fixed-case\">NAFLD<\/jats:styled-content> was present in 18% of those referred. Autoimmune hepatitis was the most common alternative diagnosis. Children with <jats:styled-content style=\"fixed-case\">NAFLD<\/jats:styled-content> had significantly (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.05) higher screening <jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content> (98\u00a0\u00b1\u00a095) than children with liver disease other than <jats:styled-content style=\"fixed-case\">NAFLD<\/jats:styled-content> (86\u00a0\u00b1\u00a074). Advanced fibrosis was present in 11% of children. For the diagnosis of <jats:styled-content style=\"fixed-case\">NAFLD<\/jats:styled-content>, screening <jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content> two times the clinical ULN had a sensitivity of 57% and a specificity of 71%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Screening of overweight and obese children in primary care for <jats:styled-content style=\"fixed-case\">NAFLD<\/jats:styled-content> with referral to paediatric gastroenterology has the potential to identify clinically relevant liver pathology. Consensus is needed on how to value the risk and rewards of screening and referral, to identify children with liver disease in the most appropriate manner.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.12518","type":"journal-article","created":{"date-parts":[[2013,10,12]],"date-time":"2013-10-12T01:32:17Z","timestamp":1381541537000},"page":"1267-1277","source":"Crossref","is-referenced-by-count":194,"title":["Paediatric gastroenterology evaluation of overweight and obese children referred from primary care for suspected non\u2010alcoholic fatty liver disease"],"prefix":"10.1111","volume":"38","author":[{"given":"J. B.","family":"Schwimmer","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition Department of Pediatrics San Diego School of Medicine University of California San Diego CA USA"},{"name":"Department of Gastroenterology Rady Children's Hospital San Diego San Diego CA USA"},{"name":"Liver Imaging Group Department of Radiology San Diego School of Medicine University of California San Diego CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. P.","family":"Newton","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition Department of Pediatrics San Diego School of Medicine University of California San Diego CA USA"},{"name":"Department of Gastroenterology Rady Children's Hospital San Diego San Diego CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. I.","family":"Awai","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition Department of Pediatrics San Diego School of Medicine University of California San Diego CA USA"},{"name":"Department of Gastroenterology Rady Children's Hospital San Diego San Diego CA USA"},{"name":"Liver Imaging Group Department of Radiology San Diego School of Medicine University of California San Diego CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. J.","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition Department of Pediatrics San Diego School of Medicine University of California San Diego CA USA"},{"name":"Department of Gastroenterology Rady Children's Hospital San Diego San Diego CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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