Diagnosis of Nonalcoholic Fatty Liver Disease in Children and Adolescents

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children and adolescents in the United States, and most probably also in the rest of the industrialized world.As the prevalence of NAFLD in childhood increases with the worldwide obesity epidemic, there is an urgent need for diagnostic standards that can be commonly used by pediatricians and hepatologists. To this end, we performed a PubMed search of the adult and pediatric literature on NAFLD diagnosis through May 2011 using Topics and/or relevant Authors as search words. According to the present literature, NAFLD is suspected based on the association of fatty liver combined with risk factors (mainly obesity), after the exclusion of other causes of liver disease. The reference but imperfect standard for confirming NAFLD is liver histology. The following surrogate markers are presently used to estimate degree of steatosis and liver fibrosis and risk of progression to end-stage liver disease: imaging by ultrasonography or magnetic resonance imaging, liver function tests, and serum markers of liver fibrosis.NAFLD should be suspected in all of the overweight or obese children and adolescents older than 3 years with increased waist circumference especially if there is a NAFLD history in relatives. The typical presentation, however, is in children ages 10 years and older. The first diagnostic step in these children should be abdominal ultrasound and liver function tests, followed by exclusion of other liver diseases. Overweight/obese children with normal ultrasonographic imaging and normal liver function tests should still be monitored due to the poor sensitivity of these tests at a single assessment.Indications for liver biopsy include the following: to rule out other treatable diseases, in cases of clinically suspected advanced liver disease, before pharmacological/surgical treatment, and as part of a structured intervention protocol or clinical research trial.

Influence of dietary pattern, physical activity, and I148M PNPLA3 on steatosis severity in at-risk adolescents

“…The growing prevalence of childhood obesity and overweight in industrialized countries is leading to a parallel surge in the prevalence of pediatric non-alcoholic fatty liver disease (NAFLD) (Vajro et al 2012;Alisi et al 2012;Loomba et al 2009). Pediatric NAFLD is not always a benign condition, with some children progressing to steatohepatitis (NASH) and fibrosis, with possible evolution to cirrhosis and liver failure (Loomba et al 2009;Feldstein et al 2009;Nobili et al 2013).…”

“…NAFLD affects 3-13 % of children and adolescents, and this figure increases up to approximately 80 % among obese individuals (Feldstein et al 2009;Nobili et al 2013). These children are at lifetime risk of developing metabolic complications such as dyslipidemia, insulin resistance, hypertension, and type 2 diabetes, as well as other features of the metabolic syndrome (Vajro et al 2012;Alisi et al 2009Alisi et al , 2012Loomba et al 2009;Feldstein et al 2009;Nobili et al 2013). During adolescence, children start following a personalized lifestyle characterized by excessive caloric intake, and sedentary lifestyle.…”

Ultrasound hepatic/renal ratio and hepatic attenuation rate for quantifying liver fat content

“…Correlation analysis revealed that the ultrasound hepatic/renal ratio and hepatic echo-intensity attenuation rate were significantly correlated with 1 H-MRS liver fat content (ultrasound hepatic/renal ratio: r = 0.952, P = 0.000; hepatic echo-intensity attenuation r = 0.850, P = 0.000). The equation for predicting liver fat content by ultrasound (quantitative ultrasound model) is: liver fat content (%) = 61.519 × ultrasound hepatic/renal ratio + 167.701 × hepatic echo-intensity attenuation rate -26.736.…”

Labordiagnostik der Leberfibrose und der nichtalkoholischen Fettleber-Krankheit

“…Ein weiteres Postionspapier der European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHN) beschäftigte sich mit der NAFLD im Kindes-und Jugendalter [25].…”