Clinical and Histological Features of Nonalcoholic Fatty Liver Disease in Children

Ko, Jae Sung; Yoon, Jung Min; Yang, Hye Ran; Myung, Jae Kyung; Kim, Haeryoung; Kang, Gyeong Hoon; Cheon, Jung Eun

doi:10.1007/s10620-009-0949-3

Cited by 60 publications

(54 citation statements)

References 21 publications

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“…This pattern is typified by marked macrovesicular hepatocellular steatosis, portal inflammation and portal fibrosis in the absence of ballooning. 192,194 Recommendation: 42. Pathologists interpreting pediatric NAFLD biopsies should recognize the unique pattern frequently found in children to not misidentify pediatric NAFLD.…”

Section: Nafld Histology In Childrenmentioning

confidence: 99%

The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

et al. 2012

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Section: Nafld Histology In Childrenmentioning

confidence: 99%

The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

et al. 2012

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“…There are several cases presented with cirrhosis. 15,16,27 First long-term follow-up study in pediatric fatty liver describe the overall survival of children with NAFLD up to 20 years. Pediatric fatty liver has shown a progressive potential.…”

Section: Natural Historymentioning

confidence: 99%

“…5,8 The presence and severity of fibrosis were consistently associated with a higher body mass index or larger waist circumference 15,21,26 and had some relation to older age, higher levels of aspartate aminotransferase and insulin. 27,29 These 'fibrosis predictors' have ranged from 10 to 25% of elevated ALT in obese adolescence to 52-77% bright liver, in sonography, in different studies in several countries.…”

Section: Pediatric Nonalcoholic Fatty Liver K Widhalm and E Ghodsmentioning

confidence: 99%

“…Other markers, such as the insulin resistance (IR) index, could have a role in screening. [14][15][16][17][18] Measurement of abdominal subcutaneous fat thickness by ultrasonography could be a good estimate for liver involvement, especially in obese subjects. [19][20][21][22][23] Population-based approaches by this method, suggests an overall prevalence of at least 3% for suspected fatty liver disease among children and adolescents in the United States and Asia.…”

Section: Introductionmentioning

confidence: 99%

“…9 Biopsy-proven NAFLD has a ratio of 2.2:1 in boys to girls on the basis of linking of clinical cases from four different continents. 15,17 Hispanic ethnicity, Asian race has shown more prevalence of fatty liver. Black children, even obese, are much less likely to have NAFLD than white children.…”

Section: Introductionmentioning

confidence: 99%

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Nonalcoholic fatty liver disease: a challenge for pediatricians

Widhalm

Ghods

2010

Int J Obes

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Background: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of pediatric liver disease. Its prevalence is related to the growing epidemic in childhood obesity during the past decades. At present, NAFLD and nonalcoholic steatohepatitis (NASH) are increasingly recognized worldwide. In spite of alarming trend in the epidemiology in pediatric field and growing risk of end stage liver disease, there is no significant advance in its diagnosis and treatment. Aim: To provide a detailed review for diagnosis and management of NAFLD and NASH. Methods: By using Pubmed to find review articles and relevant research. Results: The prevalence ranges from at least 3% in children overall to about 50% in obese children. The noninvasive biomarkers can be used to identify NAFLD/NASH patients. Diagnostic criteria based on biochemical and immunological indicators in the high-risk group of children could prevent about half of cases from receiving an invasive test. The pharmacological and surgical interventions have shown a growing role in pediatric NAFLD. Novel treatment modalities, such as probiotics, have hardly been studied. Conclusion: Early diagnosis by using noninvasive screening methods in high-risk groups is the most effective strategy against the NAFLD. The biology of early growth and development, including hepatic metabolism, may hold the key to pediatric NAFLD. Prevention of overweight children and childhood obesity is undoubtedly the best strategy for treating NAFLD.

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Portal inflammation is independently associated with fibrosis and metabolic syndrome in pediatric nonalcoholic fatty liver disease

et al. 2016

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Pediatric nonalcoholic fatty liver disease (NAFLD) histology demonstrates variable amounts of portal inflammation, which may be associated with more severe liver disease and fibrosis. We assessed the relationship between portal inflammation, hepatic fibrosis, and the metabolic syndrome in pediatric NAFLD. Children with biopsy-proven NAFLD were eligible for inclusion. Histology was assessed using Kleiner fibrosis stage and the Nonalcoholic Steatohepatitis Clinical Research Network system for portal inflammation. Patients were divided by histology into type 1, type 2, and overlap NAFLD. Multivariable ordinal logistic regression was used to determine factors associated with fibrosis and portal inflammation. The 430 Caucasian children were divided into 52 with type 1, 95 with type 2, and 283 with overlap NAFLD. Those with type 2 had a more severe metabolic phenotype, with higher body mass index z score (2.0 versus 1.6, P < 0.0001), waist circumference centile (96th versus 90th, P < 0.0001), and triglycerides (84 versus 77 mg/dL, P 5 0.01) and lower high-density lipoprotein (46 versus 60 mg/dL, P 5 0.004) than those with type 1. Similarly, those with overlap NAFLD had a more severe phenotype. Stage 2-3 fibrosis was present in 69/283 (24%) with overlap NAFLD. Portal inflammation was associated with stage 2-3 fibrosis on multivariable analysis (95% confidence interval 1.4-5.2, odds ratio 5 3.7). Waist circumference centile was associated with portal inflammation (95% confidence interval 1.2-3.4, odds ratio 5 2.0). Conclusion: Portal inflammation is associated with more advanced pediatric NAFLD and features of the metabolic syndrome. (HEPATOLOGY 2016;63:745-753)

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Clinical and Histological Features of Nonalcoholic Fatty Liver Disease in Children

Abstract: Obesity and older age are associated with development of NASH. Type 2 NASH is the most common form and associated with a greater severity of obesity and advanced fibrosis.

Cited by 60 publications

References 21 publications

The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

Nonalcoholic fatty liver disease: a challenge for pediatricians

Portal inflammation is independently associated with fibrosis and metabolic syndrome in pediatric nonalcoholic fatty liver disease

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