Objectives: To study the relationship between Non-Alcoholic Fatty Liver Disease
(NAFLD) and sleep, Physical Activity (PA), and screen-time habits/behaviors among a multiethnic
sample of overweight children/adolescents.
Methods: A retrospective medical chart review (6/2013-7/2014) identified 209 patients (7-21 years
old) who were overweight/obese (BMI > 85th% for age/sex). A follow-up telephone survey was
completed among 130 of these patients' parents to obtain information on sleep, screen-time, PA
habits, and socio-demographics. NAFLD was defined as ALT and/or AST levels above the age/sexadjusted
cutoff value in the absence of medications or associated medical conditions. Logistic regression
models were fitted to identify predictors of NAFLD by adjusting age, sex, heritage, and
Results: Over a third (34%) of the sample (N=130, 55% males, 74% Hispanic) had NAFLD. Compared
to non-Hispanics, Central American heritage subjects were over three times as likely to have
NAFLD compared to non-Hispanics (OR=3.90, 95% CI, 1.23-12.37) after adjusting for socioeconomics
and lifestyle habits. Subjects with low PA levels were at increased risk for NAFLD
(aOR=4.52, 95% CI, 1.21-16.82) compared to their more active counterparts. Lower income families
were over twice as likely to have NAFLD as higher income families (OR = 2.57, 0.95-6.96).
Conclusions: Families residing from a Central American heritage are at significant risk for NAFLD
versus their ethnic group counterparts. Identifying specific groups and risks for pediatric-onset
NAFLD can inform and improve clinical practice and public health initiatives, especially as patient
populations become more ethnically diverse across the nation.