Clinical advances in pediatric nonalcoholic fatty liver disease

Schwimmer, Jeffrey B.

doi:10.1002/hep.28441

Cited by 46 publications

(45 citation statements)

References 65 publications

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“…Thus, a clear correlation between liver disease described by standard liver function tests, such alanine aminotransferase (ALAT) or aspartate aminotransferase (ASAT), could not be established up to date [15]. In the present study, however, an alteration of PK by NAFLD seemed unlikely, especially because NAFLD is less often seen in obese adolescents compared to obese adults [24]. We therefore attribute the increased fentanyl clearance observed in our patient cohort to an increased hepatic blood flow as suggested previously.…”

Section: Discussionmentioning

confidence: 80%

Use of Fentanyl in Adolescents with Clinically Severe Obesity Undergoing Bariatric Surgery: A Pilot Study

et al. 2017

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Background The number of obese pediatric patients requiring anesthesia is rapidly increasing. Although fentanyl is a commonly used narcotic during surgery, there is no pharmacokinetic (PK) data available for optimal dosing of fentanyl in adolescents with clinically severe obesity. Materials and Methods An IRB-approved exploratory pilot study was conducted in 6 adolescents aged 14 to 19 years undergoing bariatric surgery. Mean total body weight (TBW) and mean BMI were 137.4 ± 14.3 kg, and 49.6 ± 6.4 kg/m2 (99.5th BMI percentile), respectively. Fentanyl was dosed intravenously for intraoperative analgesia based on ideal body weight per standard of care. PK blood samples were drawn over a 24 hour post-dose period. Fentanyl PK parameters were calculated by non-compartmental analysis. Results Mean fentanyl AUC0–∞ was 1.5 ± 0.5 h*ng/mL. Systemic clearance of fentanyl was 1522 ± 310 mL/min and 11.2 ± 2.6 mL/min*kg TBW. Volume of distribution was 635 ± 282 L and 4.7 ± 2.1 L/kg TBW. While absolute clearance was increased, absolute volume of distribution was comparable to previously established adult values. Conclusions These results suggest that fentanyl clearance is enhanced in adolescents with clinically severe obesity while volume of distribution is comparable to previously published studies.

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Section: Discussionmentioning

confidence: 80%

Use of Fentanyl in Adolescents with Clinically Severe Obesity Undergoing Bariatric Surgery: A Pilot Study

et al. 2017

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“…A study with 191 Italian children with biopsy confirmed NAFLD, showed hepatic steatosis, inflammation, hepatocyte ballooning, and fibrosis were worse in those children who were not breast-fed compared to those who were[20]. Similar to what has been observed in adults, obesity is a considerable risk factor for the development of NAFLD in children[21]. According to the Study of Child and Adolescent Liver Epidemiology, approximately one-third of obese children have NAFLD[22].…”

Section: Risk Factors and Etiologymentioning

confidence: 96%

Non-alcoholic fatty liver disease: An expanded review

Benedict

Zhang

2017

WJH

624

494

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Non-alcoholic fatty liver disease (NAFLD) encompasses the simple steatosis to more progressive steatosis with associated hepatitis, fibrosis, cirrhosis, and in some cases hepatocellular carcinoma. NAFLD is a growing epidemic, not only in the United States, but worldwide in part due to obesity and insulin resistance leading to liver accumulation of triglycerides and free fatty acids. Numerous risk factors for the development of NAFLD have been espoused with most having some form of metabolic derangement or insulin resistance at the core of its pathophysiology. NAFLD patients are at increased risk of liver-related as well as cardiovascular mortality, and NAFLD is rapidly becoming the leading indication for liver transplantation. Liver biopsy remains the gold standard for definitive diagnosis, but the development of noninvasive advanced imaging, biochemical and genetic tests will no doubt provide future clinicians with a great deal of information and opportunity for enhanced understanding of the pathogenesis and targeted treatment. As it currently stands several medications/supplements are being used in the treatment of NAFLD; however, none seem to be the “magic bullet” in curtailing this growing problem yet. In this review we summarized the current knowledge of NAFLD epidemiology, risk factors, diagnosis, pathogenesis, pathologic changes, natural history, and treatment in order to aid in further understanding this disease and better managing NAFLD patients.

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“…Also, the study by Schwimmer reported that the same amount was established in the pediatric population in Europe (38). In the study by Park et al, the 97.5 th percentile, ALT was 33 and 25 IU/L in males and females, respectively (40).…”

Section: Non-invasive Diagnostic Methods Of Fatty Liver In Children 2mentioning

confidence: 78%

“…In many studies, high serum levels for ALT were considered as 40 IU/L (36); although in several other studies, the cutoff points of 30 to 45 IU/L were used (37,38). Cortez-Pinto H determined the sensitivity of ALT as 80% and 92% in males and females, and its specificity as 79% and 85% in males and females, respectively (41)(42).…”

Section: Non-invasive Diagnostic Methods Of Fatty Liver In Children 2mentioning

confidence: 99%

Which Method is Superior in the Diagnosis of Nonalcoholic Fatty Liver and Steatohepatatis in Children?

et al. 2017

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Context: Nonalcoholic fatty liver disease (NAFLD) is increasing with the increased rate of obesity and reduced physical activity in children worldwide. Despite high prevalence of the disease, a standard and acceptable diagnostic method is not available. The current study aimed at collecting all related articles and evaluating the challenges. Methods:The current study searched Scopus, Web of Science, and PubMed. Articles and guidelines in English in the field of invasive and noninvasive diagnostic methods for NAFLD and nonalcoholic steatohepatitis (NASH) in children and adolescents up to Oct 2016 were used. It was tried to evaluate all laboratory and radiologic methods, biomarkers, and scores in addition to mention the challenges.Results: Ultrasonography and laboratory evaluation, which were routine methods in early diagnosis, did not have enough accuracy in this field. Diagnosis of steatosis and fibrosis and determining the severity of disease were achieved by fibro scan and controlled attenuation parameter (CAP) without the challenges of computed tomography (CT) scan and magnetic resonance imaging (MRI). Fatty liver can be predicted with high accuracy by body analyzer, anthropometric, and DEXA methods.Conclusions: Diagnosis and prediction of fatty liver should be done in all children with obesity aged > 3 years, and physician should seek the genetic and metabolic causes in children aged < 3 years and/or without overweight.

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Clinical advances in pediatric nonalcoholic fatty liver disease

Cited by 46 publications

References 65 publications

Use of Fentanyl in Adolescents with Clinically Severe Obesity Undergoing Bariatric Surgery: A Pilot Study

Use of Fentanyl in Adolescents with Clinically Severe Obesity Undergoing Bariatric Surgery: A Pilot Study

Non-alcoholic fatty liver disease: An expanded review

Which Method is Superior in the Diagnosis of Nonalcoholic Fatty Liver and Steatohepatatis in Children?

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