Ethnic and sex differences in the association between metabolic syndrome and suspected nonalcoholic fatty liver disease in a nationally representative sample of US adolescents.

OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) is increasingly recognized among overweight adolescents. Metabolic syndrome often coexists with NAFLD in adults. This study aimed to determine whether, in US adolescents, metabolic syndrome increases the odds of alanine aminotransferase (ALT)>40 U/L, a surrogate for NAFLD. MATERIALS AND METHODS: A cross-sectional study of the association between metabolic syndrome and ALT>40 U/L was undertaken in a sample of 12- to 19-year-olds from the National Health and Nutrition Examination Survey, 1999 to 2002, representative of the US adolescent population. Subjects were excluded for incomplete data, pregnancy, steroid or hepatotoxic drug use, cholestasis or viral hepatitis, and alcohol intake. The metabolic syndrome was defined by adult criteria adapted for pediatric body size and blood pressure. The association of metabolic syndrome with ALT>40 U/L, effect modifiers, and confounders were analyzed using National Health and Nutrition Examination Survey sampling weights. RESULTS: Of 4902 adolescents, the 1323 included were similar to the excluded ones, except for the important variable sex (55% vs 49% male, P=0.03, respectively). The metabolic syndrome was associated with ALT>40 U/L (odds ratio [OR] 16.7, confidence interval [CI] 6.2-45.1, P<0.001) with significant interaction by sex: OR 20.4 (CI 6.2-66.7, P<0.001) for males versus 3.1 (CI 0.4-25.1, P=0.3) for females. Further stratification of males suggested interaction by ethnicity: OR 5.0 (CI 1.3-19.0, P=0.02) for Hispanics versus 34.3 (CI 7.61-55.4, P<0.001) for non-Hispanics. Among Hispanic males, adjustment for body mass index z score explained the association (OR 0.6; CI 0.1-2.9, P=0.5), whereas among non-Hispanic males, the association remained after adjustment for BMIz (OR 11.1; CI 3.2-38.0, P<0.001). CONCLUSIONS: Metabolic syndrome is strongly associated with ALT>40 U/L in US male adolescents. Body mass index z score explained this association among Hispanics, but not among non-Hispanic males. Significant sex and ethnic differences exist in the association of pediatric metabolic syndrome with elevated ALT.

Teaching and tomorrow: a novel recruitment program for a pediatric subspecialty.

OBJECTIVES: : In 2001, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition created Teaching and Tomorrow, a novel pediatric subspecialty recruitment program to provide prospective fellows the opportunity to participate in the society's annual meeting and to interact with current trainees and members. The aims of this report are to describe participant survey data from the first 4 years of the program and to explore potential influences of participation on outcomes and proposed career choices. MATERIALS AND METHODS: : Pre- and postprogram surveys were administered during opening and closing breakfast meetings, respectively, to ascertain demographics, certainty of career intent, factors influencing choice of specialty, and anticipated benefits from participation. RESULTS: : Among 189 applications, 107 (57%) participated and 107 (57%) matriculated into gastroenterology(GI) fellowship. The matriculation rate was similar between participants and nonparticipants. Among applicants who became GI fellows, there was a 42% lower odds of being female than male (OR 0.42; chi = 8.48, P < 0.01). Among participants who completed both pre- and postprogram surveys (n = 91) and who reported certainty about entering GI both before and after, 79% entered GI fellowship. Among participants who reported uncertainty about entering GI both before and after, 8% entered GI. More participants were interested in jobs as clinician-investigators and funded clinical or translational investigators. CONCLUSIONS: : In a selected population of pediatric residents with high interest in pediatric gastroenterology, there was no difference in the matriculation rate into pediatric GI fellowship training among those who participated compared with those who did not. However, those who eventually matriculated had a higher odds of being male than female. There was a high retention rate of participants who were initially certain and a modest conversion rate of those who were initially uncertain about pursuing a career in pediatric GI.