Seth A, Orkin S, Yodoshi T, et al. - In this retrospective cohort study, researchers ascertained if the severity of obesity was correlated with non-alcoholic fatty liver disease (NAFLD) severity in children with NAFLD, as determined using histology, imaging, and serologic markers of disease severity, in patients with varying degrees of obesity. The sample consisted of patients followed at Cincinnati Children's Medical Center for NAFLD. Using biochemical, imaging (magnetic resonance elastography), and histologic evidence of liver injury, liver disease severity was determined. According to results, the odds of having alanine transaminase > 80 U/L were highest in class III obesity patients in the biochemistry cohort. There was a significant difference in liver stiffness between BMI groups of patients in the imaging cohort. In the histology cohort, there were significantly higher odds of NAFLD activity score ≥ 5 for those with Class III obesity. Findings suggested an association of obesity severity with liver disease severity. More severe obesity patients are more likely to have more advanced liver disease, a finding that can assist in risk stratification, as well as approaches to monitoring and treatment.