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However, there is limited evidence regarding what parameters should be used to initiate the screening.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective of this study was to determine whether obesity class rather than age group can identify a higher percent of children at risk of NAFLD as assessed by abnormal alanine aminotransferase (ALT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a cross\u2010sectional study in a regional referral clinic for evaluation of obesity. Children were stratified by age group or by obesity class, and data obtained at first visit were analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 784 children, 482 were\u2009\u226510, 209 were 6 to 9 and 93 were 2 to 5\u2009years of age. Abnormal ALT was observed in 32.1%, 46.9% and 61.0% of children with class I, II or III obesity, respectively (<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001), while the risk of abnormal ALT did not differ in very young (2\u20135), young (6\u20139), or children older than 10\u2009years. A multivariable analysis showed that class II and class III obesity were associated with 2.1\u2010fold (1.27\u20103.72) and 4\u2010fold (2.41\u20106.96) greater odds of abnormal ALT compared with class I obesity. African\u2010American children had lower risk of abnormal ALT (0.27), whereas Hispanic children had higher risk (2.37). Obesity class was a better predictor of abnormal ALT than age, especially in girls. Furthermore, 66.7% of boys (<jats:italic>p<\/jats:italic>\u00a0=\u20090.009) and 69% of girls (<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001) with abnormal ALT exhibited additional signs of metabolic dysfunction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Obesity class is more strongly associated with abnormal ALT than age.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijpo.12862","type":"journal-article","created":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T08:45:15Z","timestamp":1634805915000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Stratification by obesity class, rather than age, can identify a higher percent of children at risk for non\u2010alcoholic fatty liver disease and metabolic dysfunction"],"prefix":"10.1111","volume":"17","author":[{"given":"Aurelia","family":"Radulescu","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of Kentucky College of Medicine and Kentucky Children's Hospital  Lexington Kentucky USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam J.","family":"Dugan","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, College of Public Health University of Kentucky  Lexington Kentucky USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Killian","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanna L.","family":"Attia","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition College of Medicine, University of Kentucky  Lexington Kentucky 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