Main Article Content

Ifnan Shamraiz
Shaista Naz
Farooq Ikram
Saba Idrees
Husna Khan
Samina Khan


Objective: To find out the metabolic profiles and risk factors for Non-alcoholic Fatty Liver Disease (NAFLD) in obese children.

Methodology: It was cross sectional study spanning from February 2022 to June 2023, involving the inclusion of children aged 5-18 years with BMI more and equal than 95th percentile, at the paediatric unit of combined military hospital, Rawalpindi. Thorough evaluations, encompassing anthropometric measurements, lipid profiles, thyroid levels, LFTs, FBS assessments, and blood pressure measurements, were systematically performed. The diagnosis of NAFLD was established through the use of ultrasonography by detecting fatty changes in the liver by evaluating the liver's echogenicity in comparison to the kidney, portal vein, and diaphragm.

Results: The study examined 82 children, having mean age of 10.46 ± 3.8 yrs with a mean Body mass index-Z score of 2.45 ± 0.45. Notably, 63.4% of the obese children were identified with NAFLD. Among those with NAFLD, elevated alanine transaminase (ALT) levels were significantly elevated compared to their non-NAFLD counterparts (p-value < 0.05). Additionally, a significant association was found between NA- Fatty Liver Disease and waist circumference (p-value<0.05). Conversely, no statistically significant associations were noted between NAFLD and lipid profile, fasting blood sugar levels, hypertension, sub-clinical hypothyroidism, acanthosis nigricans, and family history of obesity, hypertension, and diabetes mellitus (p-value>0.05). However, daily screen time, daily playtime, and the type of daily food exhibited significant associations with NAFLD (p-value < 0.05).

Conclusion: NAFLD is notably prevalent among obese children. Timely diagnosis is crucial as untreated NAFLD can progress to chronic liver disease and contribute to significant morbidity in children.

Article Details

How to Cite
Shamraiz I, Naz S, Ikram F, Idrees S, Khan H, Khan S. NON-ALCOHOLIC FATTY LIVER DISEASE IN OBESE CHILDREN: FREQUENCY, METABOLIC PROFILES, AND ASSOCIATED RISK FACTORS. J Postgrad Med Inst [Internet]. 2024 May 8 [cited 2024 Jun. 17];38(2):152-9. Available from:
Original Article


Mahmood H, Abbas M, Azeem M, Younus I, Qadir A, Habib M. The risk factors associated with non-alcoholic fatty liver disease. P J M H S. 2023;17 (4) 458-61. DOI:

Shah J, Okubote T, Alkhouri N. Overview of updated practice guidelines for pediatric nonalcoholic fatty liver disease. Gastroenterol Hepatol 2018;14(7):407-14.

Abbas Z, Zaheer R. Non-alcoholic fatty liver disease: A real threat in Pakistan. J Pak Med Assoc 2020;70(12(B)):2437-40. DOI:https://doi: 10.5455/JPMA.

Temple JL, Cordero P, Li J, Nguyen V, Oben JA. A guide to non-alcoholic fatty liver disease in childhood and adolescence. Int J Mol Sci 2016;17(6):947. DOI: https://doi: 10.3390/ijms17060947.

Berardis S., Sokal E. Pediatric non-alcoholic fatty liver disease: An increasing public health issue. Eur. J. Pediatr 2014;173:131–39. DOI: https://doi: 10.1007/s00431-013-2157-6.

Yu EL, Golshan S, Harlow KE, Angeles JE, Durelle J, Goyal NP, et al. Prevalence of nonalcoholic fatty liver disease in children with obesity. J Pediatr 2019;207:64-70. DOI: https://doi: 10.1016/j.jpeds.2018.11.021.

Peng L, Wu S, Zhou N, Zhu S, Liu Q, Li X. Clinical characteristics and risk factors of nonalcoholic fatty liver disease in children with obesity. BMC Pediatr 2021; 21:22.

Zubair R, Mirza M, Iftikhar J, Saeed N. Frequency of incidental fatty liver on ultrasound and its association with diabetes mellitus and hypertension. Pak J Med Sci. 2018;34(5):1137-41. DOI: https://doi: 10.12669/pjms.345.15102.

Tanveer M, Hohmann A, Roy N, Zeba A, Tanveer U, Siener M. The current prevalence of underweight, overweight, and obesity associated with demographic factors among Pakistan school-aged children and adolescents-An empirical cross-sectional study. Int J Environ Res Public Health 2022;19(18):11619. DOI: https://doi: 10.3390/ijerph191811619.

Monasor-Ortolá D, Quesada-Rico JA, Nso-Roca AP, Rizo-Baeza M, Cortés-Castell E, Martínez-Segura A, et al. Degree of accuracy of the BMI Z-Score to determine excess fat mass using DXA in children and adolescents. Int J Environ Res Public Health 2021;18(22):12114. DOI: https://doi: 10.3390/ijerph182212114.

Yamanaka AB, Davis JD, Wilkens LR, Hurwitz EL, Fialkowski MK, Deenik J, et al. Determination of child waist circumference cut points for metabolic risk based on acanthosis nigricans, the children’s healthy living program. Prev Chronic Dis 2021;18:210021. DOI:

Rutigliano I, De Filippo G, Pastore L, Messina G, Agostoni C, Campanozzi A. Obesity-related hypertension in pediatrics, the impact of American academy of pediatrics guidelines. Nutrients 2021;13(8):2586. DOI: https://doi: 10.3390/nu13082586.

Lu Y, Wang Q, Yu L, Yin X, Yang H, Xu X, et al. Revision of serum ALT upper limits of normal facilitates assessment of mild liver injury in obese children with non-alcoholic fatty liver disease. J Clin Lab Anal 2020;34(7):e23285. DOI: https://doi: 10.1002/jcla.23285.

Balkhiyarova Z, Luciano R, Kaakinen M, Ulrich A, Shmeliov A, Bianchi M, et al. Relationship between glucose homeostasis and obesity in early life-a study of Italian children and adolescents. Human Molecular Genetics 2022;31(5)816–26. doi:

Cigri E, Inan FC, Er E, Yildiz E. The relationship between lipid profile and non-alcoholic fatty liver disease in children and adolescents with obesity. J Coll Physicians Surg Pak 2022; 32(05):591-95. DOI: 10.29271/jcpsp.2022.05.591

Ayub A, Irfan M, Nadeem A, Hayee S, Akhtar N, Nawaz F. Profiles of thyroid hormones in the overweight boys of district Rawalpindi, Punjab, Pakistan. PJEST 2023;4(3)1–8.

A. Kim PH, Cho YA, Yoon HM, Bak B, Lee JS, Jung AY, et al. Accuracy of attenuation imaging in the assessment of pediatric hepatic steatosis: correlation with the controlled attenuation parameter. Ultrasonography. 2022;41(4):761-69. doi: 10.14366/usg.21246.

Altalebi RR, Al-Hussaniy HA, Al-Tameemi ZS, Al-Zobaidy MA, Albu-Rghaif AH, Alkuraishy HM, et al. Non-alcoholic fatty liver disease: relation to juvenile obesity, lipid profile, and hepatic enzymes. J Med Life 2023;16(1):42-7. doi: 10.25122/jml-2022-0091.

Akther R, Begum S, Alam F, Shymali KJ, Tithi BB, Rezaul Karim MR. Non-alcoholic fatty liver disease in obese and overweight children. Int J Contemp Pediatr 2021;8:976-80. DOI:

Gupta N, Jindal G, Nadda A, Bansal S, Gahukar S, Kumar A. Prevalence and risk factors for nonalcoholic fatty liver disease in obese children in rural Punjab, India. J Family Community Med. 2020;27(2):103-8. doi: 10.4103/jfcm.JFCM_287_19.

Pawar SV, Zanwar VG, Choksey AS, Mohite AR, Jain SS, Surude RG, et al. Most overweight and obese Indian children have nonalcoholic fatty liver disease. Ann Hepatol 2016;15(6):853-61. doi: 10.5604/16652681.1222101.

Parry IA, Bhat RA, Khan I. The prevalence of non-alcoholic fatty liver disease and its association with metabolic syndrome and obesity in pediatric population of North India. J Metabolic Synd 2012;1:118. doi:10.4172/2167-0943.1000118

Kodhelaj K, Resuli B, Petrela E, Malaj V, Jaze H. Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in Albanian overweight children. Minerva Pediatr 2014;66(1):23-30.

Jimenez-Rivera C, Hadjiyannakis S, Davila J, Hurteau J, Aglipay M, Barrowman N, et al. Prevalence and risk factors for non-alcoholic fatty liver in children and youth with obesity. BMC Pediatr 2017;17(1):113. doi: 10.1186/s12887-017-0867-z.

Thiagarajan S, Shrinuvasan S, Arun Babu T. Screening for non-alcoholic fatty liver disease among obese and overweight children: prevalence and predictors. Indian J Gastroenterol 2022;41(1):63-8. doi: 10.1007/s12664-021-01198-0.

Jalilian M, Rasad R, Rotbeh A. Fatty liver disease in overweight and obese Iranian children: comprehensive systematic review and meta-analysis. Obesity Medicine 2022;35:2451-8476.

Mburu AN, Laving A, Macharia WM, Sande J. Prevalence of non-alcoholic fatty liver disease in overweight and obese children seeking ambulatory healthcare in Nairobi, Kenya. BMJ Open Gastroenterol 2023;10(1):e001044. doi: 10.1136/bmjgast-2022-001044.

Maleki F, Hosseinpour M, motlagh BM. OC49 Non-alcoholic fatty liver disease in obese and overweight iranian children: a cross sectional study. Archives of Disease in Childhood 2019;1*04:A20-A21.

Hassanipour S, Amini-Salehi E, Joukar F, Khosousi MJ, Pourtaghi, Ansar MM, et al. The prevalence of non-alcoholic fatty liver disease in Iranian children and adult population: A systematic review and meta-analysis. Iran J Public Health 2023;52(8)1600-12. DOI:

Jain V, Jana M, Upadhyay B, Ahmad N, Jain O, Upadhyay AD, et al. Prevalence, clinical and biochemical correlates of non alcoholic fatty liver disease in overweight adolescents. Indian J Med Res 2018;148:291 301. DOI: 10.4103/ijmr.IJMR_1966_16.

Imanzadeh F, Olang B, Sayyari AA, Dara N, Khatami K, Hosseini A, et al. Prevalence and related factors for non-alcoholic fatty liver disease in obese students. J Compr Ped 2023;14(3):e135095. DOI: