https://www.ncbi.nlm.nih.gov/pubmed/29799476 NAFLD
Children (Basel). 2018 May 25;5(6). pii: E64. doi: 10.3390/children5060064.Alanine Aminotransferase as a Monitoring Biomarker in Children with Nonalcoholic Fatty LiverDisease: A Secondary Analysis Using TONIC Trial Data.Arsik I1, Frediani JK2, Frezza D3, Chen W4, Ayer T5, Keskinocak P6, Jin R7, Konomi JV8, Barlow SE9, Xanthakos SA10, Lavine JE11, Vos MB12.

Abstract

BACKGROUND:

Validated noninvasive biomarkers to assess treatment response in pediatric nonalcoholic fatty liver disease (NAFLD) are lacking. We aimed to validate alanine aminotransferase (ALT), a monitoring biomarker for change in liver histology.

METHODS:
A retrospective analysis using data from the TONIC trial. NAFLD histologic assessments were defined by: Fibrosis score, NAFLD activity score (NAS), nonalcoholic steatohepatitis (NASH), and a combination of NASH resolution and fibrosis (NASH + fibrosis). Analysis was performed using classification and regression trees (CART) as well as logistic regression.

RESULTS:
Mean ALT for the child over 96 weeks and percent change of ALT from baseline to 96 weeks were significant predictors of progression of NAFLD for each histologic assessment (p < 0.001 for fibrosis score, NASH, and NASH + fibrosis and p < 0.05 for NAS). Mean ALT adjusted for age, sex and ethnicity was a better predictor for change in NASH (81.8 (11.0) ROC (receiver operating characteristic curve) mean (SD (Standard derivation))) and NASH + fibrosis (77.8 (11.2)), compared to change in NAS (63 (17.7)) and fibrosis (58.6 (11.1)).

CONCLUSION:
Mean ALT over 96 weeks is a reasonable proxy of histologic improvement of NASH and NASH + fibrosis. These findings support ALT as a valid monitoring biomarker of histologic change over time in children with NASH and fibrosis.