A 14-year-old boy who is obese (body mass index, 27.5 kg/m2) presents with severe hepatic steatosis, as shown on ultrasound imaging.
Relevant laboratory values are as follows:
Hypertransaminasemia alanine transaminase, 188 U/L
Aspartate aminotransferase, 85 U/L
Homeostasis model assessment of insulin resistance, 5.4
Triglycerides, 210 mg/dL (>95th percentile)
Low-density lipoprotein, 110 mg/dL (>95th percentile)
High-density lipoprotein, 28 mg/dL (<5th percentile)
These results indicate that this boy also has hyperinsulinemia and dyslipidemia.
On the basis of these results, and after excluding all other causes of fatty liver, a liver biopsy was performed; this is in accordance with guidelines issued by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition.
The child was diagnosed with nonalcoholic steatohepatitis (NASH), as determined by a nonalcoholic fatty liver disease (NAFLD) Activity Score (NAS) of 7. Other notable findings included:
Lobular inflammation, 2
Portal inflammation, 2
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