上海市闵行区儿童青少年非酒精性脂肪肝病7年患病率横断面调查

背景：儿童非酒精性脂肪肝病（NAFLD）导致成年后心血管病发病风险明显增加，而目前我国儿童青少年一般人群NAFLD患病率研究十分有限，长期变化趋势亦不明确。目的：描述儿童青少年NAFLD患病流行趋势。设计：横断面调查。方法：以上海市闵行区2014至2020年参加健康体检的住校学生为调查对象。将ALT水平高于一般人群性别和年龄别P97.5水平定义为疑似NAFLD，依此估计疑似NAFLD患病率（简称患病率）。根据全国标准分别以BMI和腰围定义一般性肥胖和腹型肥胖。通过计算平均年度变化百分比（AAPC）及其95%CI行描述NAFLD患病率逐年变化幅度，趋势性检验Logistic回归分析，并校正BMI和腰围。主要结局指标：NAFLD患病率。结果：NAFLD总体患病率为5.1%，从2014年至2020年上升了2.5倍（2.1%到7.4%），NAFLD患病率逐年上升（Ptrend<0.001），AAPC为0.9%（95%CI：0.1%~1.7%），且男孩高于女孩（6.3% vs 3.7%）。在体重正常人群中NAFLD患病率为1.9%，7年中呈逐年上升趋势（Ptrend<0.001）。调整BMI和腰围后，NAFLD患病率逐年上升的趋势仍显著（Ptrend<0.001）。结论：上海儿童青少年人群NAFLD患病率呈现每年上升近1.0%的趋势，调整BMI和腰围因素后，NAFLD患病率逐年上升的趋势仍然存在。提示除肥胖外，儿童人群防控NAFLD需进一步关注其他可干预危险因素的作用。

7-year longitudinal prevalence of nonalcoholic fatty liver disease in children and adolescents in Shanghai Minhang District: A cross-sectional survey from 2014 to 2020

Background：Childhood nonalcoholic fatty liver disease (NAFLD) can significantly increase the risk of cardiovascular disease in adults, however, the studies investigating the NAFLD prevalence in general children and adolescents were scarce and the long term tendencies of NAFLD prevalence is unclear. Objective：To assess the trend of NAFLD prevalence in children and adolescents. Design：A cross-sectional survey. Methods：Resident students aged 11-17 years who annually participated in the 2014 2020 routine health checks in Shanghai, Minhang District were included for the analysis. Suspected NAFLD was defined by the elevation of 97.5 percentile of alanine aminotransferase (ALT) levels according to the age and sex specific reference intervals for the healthy children. The general obesity and abdominal obesity were defined by the body mass index (BMI) and waist according to the China national standards for pediatric population. The annual prevalence change of NAFLD was depicted by calculating the average annual percentage change (AAPC) and 95% confidence intervals (CIs). We used logistic regression by adjusting BMI and waist circumference to assess the temporal trend of NAFLD prevalence over years. Main outcome measures：NAFLD prevalence. Results：The overall NAFLD prevalence was 5.1% increasing 2.5 times from 2014 to 2020 (2.1% to 7.4%), with an AAPC of 0.9% (95%CI: 0.1-1.7) and Ptrend<0.001. Boys had a higher level of NAFLD rate than that of girls (6.3% vs 3.7%). The NAFLD rate in normal weight population was 1.9%, and the elevated trend was still observed in normal weight (Ptrend<0.001) among the 7-year survey. After adjusting BMI and waist, the NAFLD prevalence was still had an increasing trend over year (Ptrend<0.001). Conclusion：NAFLD prevalence of children and adolescents in Shanghai increased nearly 1.0% per year. The increasing trend of NAFLD prevalence remains even after adjustment for BMI and waist. This trend calls for attention on the modifiable risk factors in addition to obesity in this population.