Correlation between Ultrasonography and Fibroscan study for Early Detection of Nonalcoholic Fatty Liver Disease in Children with Simple Obesity

Background: Obesity is a major public health crisis among both children and adults and contributes to significant physical, psychological, and economic burdens. Nonalcoholic fatty liver disease (NAFLD) in children is strongly associated with obesity. Currently, the advised screening tools for NAFLD include serum ALT and conventional B-mode ultrasound (US), but they have poor accuracy for detecting and grading steatosis. In recent years, the controlled attenuation parameter (CAP) became available on the FibroScan device for the detection of hepatic steatosis. Aim and Objective: To compare hepatic sonographic and FibroScan results to assess their role in the early detection of NAFLD in a group of Egyptian children with simple obesity; to study the relationship between these findings and obesity-related metabolic indices of NAFLD; and to provide practical training for the candidate to gain experience in liver sonography and FibroScan techniques. Patients and Methods: This was a cross-sectional, descriptive, comparative study conducted on 100 Egyptian children (50 cases and 50 controls), aged 6–15 years, selected consecutively from the inpatient and outpatient clinics of Al-Zahraa University Hospital. All studied children underwent full medical history taking, complete clinical and systemic examinations including anthropometric measurements (weight, height, BMI, waist circumference, and waist-to-height ratio), laboratory investigations (liver enzymes, lipid profile, HOMA-IR, HbA1c, fasting blood glucose, and insulin), and radiological investigations (abdominal ultrasound and hepatic FibroScan). Results: Sixty percent of the studied obese children had a family history of obesity, and 66% had a family history of type 2 diabetes. Based on US findings, 86% of the obese children had hepatomegaly, and 76% had a bright echogenic pattern. According to hepatic steatosis grading by FibroScan, the obese children were distributed as follows: 48% S0, 14% S1, 12% S2, and 26% S3. Hepatic fibrosis grading showed that 96% had F0–F1 and 4% had F2. A significant relationship was found between hepatic steatosis by FibroScan and ALT levels, bright echogenicity, and liver stiffness measurement (LSM), but not with other studied parameters. A significant association was observed between liver size by US and age, ALT level, and waist-to-height ratio. Bright liver echogenicity was significantly associated with waist-to-height ratio, ALT level, and steatosis by FibroScan. A positive correlation was found between liver size by US and age, waist circumference, diastolic blood pressure, AST, and LSM levels. CAP was positively correlated with LSM, and LSM was positively correlated with age, weight, height, BMI, blood pressure, ALT, and liver size by US. Conclusion: CAP can predict hepatic steatosis at a cutoff value of >230 with a sensitivity of 73.68% and specificity of 93.55%. LSM can predict hepatic fibrosis at a cutoff value of >4.2 with a sensitivity of 57.89% and specificity of 66.13%.