The majority of pediatric patients with biopsy proven NASH have insulin resistance (IR), however data are scarce as to the relationship between NASH and T2D in children. Clinical guidelines advise using gender-specific ALT levels (girls 22 U/L; boys 26 U/L) to screen obese or overweight children with risk factors such as IR or T2D for NAFLD/NASH. We accessed ALT, AST, and A1C results from the LabCorp® clinical database in children 7-17 years of age with suspected or confirmed T2D, NASH, or both NASH + T2D (having ICD10 codes E11 (T2D), K75.81 (NASH), or E11 + K75.81), from March 2016-2019. Of the 19,522 patients with a T2D code, median ALT values were below the gender specified norms, while 25% were higher. Median ALT levels in both genders with a code for NASH were 2.5 times greater than those with T2D and no NASH code; 72% of those with NASH codes were male. Interestingly, boys with codes for T2D and NASH had higher ALT values, despite higher mean A1C values for girls. These vast LabCorp® data show a male predominance in use of the NASH code. As expected, ALT values are higher among patients with this code relative to the T2D code, with much higher levels among boys with codes for T2DM + NASH. Of those with T2D codes, 25% had ALT values above the cut off, suggesting need for further evaluation to confirm NAFLD/NASH.
M. Puri: Employee; Self; LabCorp. K.M. Lizzi-Ansok: Employee; Self; LabCorp. C.M. Filozof: Employee; Self; Covance. B.J. Goldstein: Employee; Self; Covance / LabCorp.