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This study has received public funding, via an external competitive call, from the Departament de Salut (Generalitat de Catalunya) through the PERIS 2021 program, under the Grants for research projects oriented to Primary Health Care call for proposals. The project has been funded under the title Clinical epidemiology of non-alcoholic fatty liver disease in children and adolescents. LiverKids Study. and under the file number SLT/21/000047. The funding agency has not been and will not be involved in any way in the development of this study, neither in the design, collection, analysis and interpretation of data, nor in the writing of this manuscript.

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Gines, PAuthorGraupera, IAuthor

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Clinical epidemiology of non-alcoholic fatty liver disease in children and adolescents. The LiverKids: Study protocol

Publicated to:Plos One. 18 (10): e0286586- - 2023-10-13 18(10), DOI: 10.1371/journal.pone.0286586

Authors: Chacon, Carla; Arteaga, Ingrid; Martinez-Escude, Alba; Rojano, Irene Ruiz; Lamonja-Vicente, Noemi; Caballeria, Llorenc; Diez, Ana Maria Ribatallada; Schroder, Helmut; Montraveta, Montserrat; Bovo, Maria Victoria; Gines, Pere; Pera, Guillem; Diez-Fadrique, Galadriel; Pachon-Camacho, Alba; Alonso, Nuria; Graupera, Isabel; Toran-Monserrat, Pere; Exposito, Carmen

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Abstract

BackgroundNon-alcoholic fatty liver disease (NAFLD) is rapidly increasing alongside overweight and obesity, not only in adults but also in children and adolescents. It is unknown what impact the development of NAFLD in childhood may have in later life. The importance of early detection and treatment lies in its potential for progression to cirrhosis, liver cancer and liver-related death, as well as its associated extrahepatic comorbidities. Vibration-Controlled Transient Elastography (VCTE) with Controlled Attenuation Parameter (CAP) is an effective, non-invasive and safe diagnostic method to estimate the degree of fibrosis and steatosis in the liver, but little is known about its applicability in the paediatric population. Aims1) To assess the prevalence of significant liver fibrosis (Liver Stiffness Measurement (LSM) >= 6.5 kPa) using VCTE, and that of non-alcoholic fatty liver disease (>= 225 dB/m) using CAP in children and adolescents. 2) To determine the optimal cut-off points of the CAP to achieve maximum concordance with the Magnetic Resonance Imaging (MRI) findings in the diagnosis of mild, moderate and severe NAFLD in children and adolescents. MethodsCross-sectional population-based study which will include 2,866 subjects aged between 9 and 16 years. Participants will undergo: anamnesis, physical examination, blood extraction, VCTE, MRI and questionnaires on socio-demographic data, personal and family medical history and lifestyle assessment. Applicability and relevanceThe study aims to establish the foundations for the use of VCTE in children and adolescents in order to achieve early diagnosis of NAFLD. Moreover, it will serve to understand in further detail the disease and to identify the risk groups of children and adolescents who may be at risk of developing it. Ultimately, this will help determine to which subgroups of the population we need to target resources for prevention and early detection of this entity, as well as possible intervention for its treatment.

Keywords

AdolescentAdultAlanine aminotransferaseAlkaline phosphataseArticleBilirubinChildControlled attenuation parameterCreatinineCross-sectional studiesCross-sectional studyDiagnosisDiagnostic imagingElasticity imaging techniquesElastographyEndoscopic retrograde cholangiopancreatographyFatty liverFibrosisGamma glutamyltransferaseHepatic steatosisHepatologyHumanHuman alphaherpesvirus 1HumansIndexLifestyle modificationLiverLiver cirrhosisLiver diseaseLiver fibrosisLiver stiffnessLiver toxicityMedical studentMediterranean dietMetabolic syndromeNon-alcoholic fatty liver diseaseNonalcoholic fatty liverNuclear magnetic resonance imagingObesityPathologyPhysical examinationPopulationProceduresRecommendationsThyrotropinTransient elastographyTriacylglycerolValidityVibration controlled transient elastography

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Plos One due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2023, it was in position 32/134, thus managing to position itself as a Q1 (Primer Cuartil), in the category Multidisciplinary Sciences.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 5.92, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-05, the following number of citations:

  • WoS: 5
  • Scopus: 7
  • OpenCitations: 5

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-06-05:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 45.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 45 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 1.
  • The number of mentions on the social network X (formerly Twitter): 1 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.