A Guide to Non-Alcoholic Fatty Liver Disease in Childhood and Adolescence

Abstract

Non-Alcoholic Fatty Liver Disease (NAFLD) is now the most prevalent form of chronic liver disease, affecting 10%–20% of the general paediatric population. Within the next 10 years it is expected to become the leading cause of liver pathology, liver failure and indication for liver transplantation in childhood and adolescence in the Western world. While our understanding of the pathophysiological mechanisms underlying this disease remains limited, it is thought to be the hepatic manifestation of more widespread metabolic dysfunction and is strongly associated with a number of metabolic risk factors, including insulin resistance, dyslipidaemia, cardiovascular disease and, most significantly, obesity. Despite this, ”paediatric” NAFLD remains under-studied, under-recognised and, potentially, undermanaged. This article will explore and evaluate our current understanding of NAFLD in childhood and adolescence and how it differs from adult NAFLD, in terms of its epidemiology, pathophysiology, natural history, diagnosis and clinical management. Given the current absence of definitive radiological and histopathological diagnostic tests, maintenance of a high clinical suspicion by all members of the multidisciplinary team in primary and specialist care settings remains the most potent of diagnostic tools, enabling early diagnosis and appropriate therapeutic intervention.

Metabolic syndrome in children and adolescents

“…Referral to a pediatric hepatologist is recommended for levels that exceed twice the upper limit of normal (42). It is suggested that screening for liver disease be performed bi-annually starting at the age of 10 years for children with obesity or for those who are overweight with other risk factors (42,43).…”

Congestion Index of Portal Vein in the Evaluation of Liver Disease

“…This could account for the relatively subtle changes seen in congestion index of paediatric patients affected by NAFLD than adult patients. 10 Also the prevalence of NAFLD in children is increasing with changing lifestyles and it is as high as more than 10 % according to study by Alterio et al 11 . NAFLD is expected to become the leading cause of liver pathology, liver failure and indication for liver transplantation in childhood and adolescence.…”

Recognising and intervening in non-alcoholic fatty liver disease

“…[2] It describes a spectrum of chronic liver disease, characterised by the excessive accumulation of fat within the liver (hepatic steatosis) in the absence of significant alcohol consumption. 1 in 4 patients with hepatic steatosis will go on to develop a more advanced form of the disease, Non-alcoholic Steatohepatitis (NASH), where steatosis coexists with liver inflammation, liver damage, scarring and, eventually, cirrhosis.…”

“…1 in 4 patients with hepatic steatosis will go on to develop a more advanced form of the disease, Non-alcoholic Steatohepatitis (NASH), where steatosis coexists with liver inflammation, liver damage, scarring and, eventually, cirrhosis. [2] NASH is also associated with a greatly increased risk of liver cancer. Some studies have even suggested that patients with steatosis, only, are also at an increased risk of liver cancer.…”

“…It is characterised by excessive amounts of adipose tissue (fat), either subcutaneously (under the skin) or viscerally (around the internal organs) and is strongly associated with an increased risk of heart disease, stroke, type II diabetes, as well as numerous psychiatric disorders and cancers. [2] The impact of obesity upon the physical and psychological health of millions of people across the UK is immense and the increasing economic burden this places upon a healthcare system with already limited resources is unsustainable.…”