Early Childhood Weight Gain Predicts Elevated ALT at Age 8 in Japanese Children
Overview
This prospective cohort study from the Japan Environment and Children’s Study found that accelerated weight gain during early childhood, particularly from birth to age 1, is associated with higher alanine aminotransferase (ALT) levels at age 8. Birth weight was not significantly linked to ALT, suggesting postnatal adiposity gain rather than prenatal growth influences liver enzyme elevations.
Background
Childhood is marked by rapid increases in lean and fat mass, with excessive weight gain posing a risk for metabolic dysfunction-associated steatotic liver disease (MASLD). Prior studies have indicated BMI trajectories diverge around ages 2 to 3 in children with MASLD, but BMI does not differentiate fat from lean mass. Conditional weight, adjusting for height and prior weight, may better capture adiposity relevant to liver health. Elevated ALT is a biomarker of hepatocellular injury and MASLD is a common cause of ALT elevation in children, warranting investigation into the timing of adiposity-related liver injury.
Data Highlights
Measure
Age
Association with ALT at 8 years
Birth weight z-score
Birth
No significant association
Conditional weight
1 year
Positive association with ALT
Conditional weight
2-6 years
No significant association
Key Findings
Higher conditional weight gain from birth to age 1 year is significantly associated with elevated serum ALT levels at age 8.
Birth weight z-scores, used as proxies for prenatal growth, showed no significant relationship with ALT at age 8.
Conditional weight gains between ages 2 and 6 years were not significantly linked to ALT elevations.
ALT elevations likely reflect early postnatal adiposity rather than intrauterine growth effects.
The study utilized a large, prospective Japanese birth cohort with standardized anthropometric and biochemical measurements.
Clinical Implications
These findings highlight the importance of monitoring and managing weight gain during the first year of life to potentially reduce the risk of early liver injury indicated by elevated ALT. Clinicians should consider early interventions targeting adiposity in infancy to prevent the development of MASLD. Routine ALT screening in children with rapid early weight gain may aid in early identification of those at risk.
Conclusion
Accelerated weight gain during infancy, rather than birth weight or later childhood weight changes, is associated with elevated ALT at age 8, underscoring infancy as a critical window for interventions to protect liver health.
References
Japan Environment and Children’s Study (JECS) -- Impact of Early Weight Gain on ALT Levels at Age 8
