Nonalcoholic fatty liver disease and bariatric surgery in adolescents

Holterman, Ai Xuan; Gurria, Juan P.; Tanpure, Smita; DiSomma, Nerina M.

doi:10.1053/j.sempedsurg.2013.10.016

Cited by 21 publications

(28 citation statements)

References 152 publications

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“…Given the relation of obesity to NAFLD and the benefit of weight loss in this population, bariatric surgery has been proposed as a potential therapy. Three forms of bariatric surgery are used, restrictive procedures (gastric banding or sleeve gastrectomy), malabsorptive procedures (bilopancreatic diversion) and the combination procedure [Roux‐en‐Y gastric bypass (RYGB)] . A reduction in hepatic injury occurs through the loss of fat mass and systemic inflammation, improvement in insulin resistance, increase in beneficial adipokines and modification of the intestinal microbiome …”

Section: Introductionmentioning

confidence: 99%

Review article: the management of paediatric nonalcoholic fatty liver disease

Mitchel

Lavine

2014

Aliment Pharmacol Ther

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Summary Background Paediatric nonalcoholic fatty liver disease (NAFLD) is a major public health concern given the recent increase in its prevalence and link to obesity and other metabolic comorbidities. Current treatment strategies involve lifestyle changes. Other surgical and pharmacologic interventions have been proposed; however, limited randomised controlled trials (RCTs) in the paediatric population restrict their use. Aim To review the current management of paediatric NAFLD, including lifestyle and pharmacologic interventions, and to formulate recommendations for study design for future studies. Methods A MEDLINE, Pubmed and Cochrane Review database search used a combination of keywords, including NAFLD, nonalcoholic steatohepatitis (NASH), paediatric, treatments, lifestyle changes, bariatric surgery, orlistat, metformin, thiazolidinediones, vitamin E, cysteamine bitartrate, ursodeoxycholic acid (UDCA), probiotics, omega‐3 fatty acids, pentoxyfylline, farnesoid X receptor agonist and toll‐like receptor modifiers. The articles were selected based on their relevance to the review. Results Lifestyle interventions involving diet and exercise remain first‐line treatment for paediatric NAFLD. Bariatric surgery, orlistat, insulin sensitisers and UDCA have been evaluated but are not recommended as first or second‐line therapy. Medications such as cysteamine bitartrate, probiotics, polyunsaturated fats and pentoxyfilline share beneficial effects in trials, however, there is a paucity of adequately powered RCTs in which liver histology is evaluated. Vitamin E has been shown to be effective and safe in improving NASH histology in children. Conclusions Lifestyle intervention should be first‐line treatment for paediatric NAFLD. Vitamin E should be considered for those with biopsy‐proven NASH or borderline NASH failing first‐line therapy. Other therapeutics show promising results but require larger RCTs with convincing endpoints. Improved screening techniques, objective validated inclusion criteria and outcome measures as well as rigour in study design are necessary for propelling therapeutic discovery.

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Section: Introductionmentioning

confidence: 99%

Review article: the management of paediatric nonalcoholic fatty liver disease

Mitchel

Lavine

2014

Aliment Pharmacol Ther

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“…Bei der Planung einer Therapie sollte ein multidisziplinäre Zusammenarbeit zwischen Hausarzt und den pädiatrischen Subspezialisierungen der Endokrinologie, Diabetologie und Gastroenterologie angestrebt werden. Eine frühzeitige Diagnose und Intervention bedeutet für die Patienten eine Verbesserung der allgemeinen Lebensqualität und eine Verringerung der Langzeitfolgen, der kardiovaskulären und hepatischen Morbidität und Mortalität (33)(34)(35).…”

Section: Management Der Nafl Im Kindes-und Jugendalterunclassified

Fettlebererkrankung bei Kindern und Jugendlichen

Penke¹,

Schuster²,

Händel³

et al. 2017

Adipositas - Ursachen, Folgeerkrankungen, Therapie

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ZusammenfassungDie nicht-alkoholbedingte Fettlebererkrankung (NAFL) ist selbst bei Kindern und Jugendlichen eine der häufigsten chronischen Lebererkrankungen in den westlichen Industriestaaten. NAFL ist assoziiert mit Übergewicht, kardiovaskulären Erkrankungen oder Typ-2-Diabetes. Die Kombination von Risikofaktoren, wie z.B. Übergewicht, ungünstige Ernährungsgewohnheiten, Umweltfaktoren und genetische Prädisposition, führt zur Entwicklung einer einfachen Steatose im Kindes- und Jugendalter, die sich im weiteren Verlauf zur Steatohepatitis, Leberfibrose und Zirrhose entwickeln kann. Als wichtigste Voraussetzung, um eine NAFL im Kindes- und Jugendalter festzustellen, muss diese Diagnose überhaupt in Betracht gezogen werden. Erste Hinweise geben dabei erhöhte Alanin-Aminotransferase-Spiegel und eine generalisierte Echogenitätsanhebung in der Leberultraschalluntersuchung. Die histologische Begutachtung einer Leberbiopsie stellt den Goldstandard der NAFL-Diagnostik dar. Die Therapie sollte in Abhängigkeit von weiteren Komorbiditäten des Patienten, wie z.B. Hyperlipidämie oder Insulinresistenz individuell abgestimmt werden, um Spätfolgen im Erwachsenenalter möglichst früh entgegenzuwirken.

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“…In fact, the prevalence of severe obesity has increased 1.5 times over the past 10 to 20 years . Though child and adolescent obesity has been clearly linked to both immediate and long‐term negative health outcomes, those with severe obesity are at even greater risk . Studies have found those with severe obesity to be at an increased risk for metabolic syndrome, multiple cardiac risk factors, and adult obesity relative to those who have obesity or BMI in the overweight range .…”

Section: Introductionmentioning

confidence: 99%