Nonalcoholic Fatty Liver Disease In Children: Recent Practice Guidelines, Where Do They Take Us?

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children and adolescents in the United States. It is strongly associated with childhood obesity, insulin resistance and metabolic syndrome. Although some children with NAFLD may remain asymptomatic, progression to nonalcoholic steatohepatitis (NASH), and to advanced stages of fibrosis and cirrhosis is well recognized. Unfortunately, despite the increase in awareness of this disease, there are still no reliable non-invasive diagnostic tests and liver biopsy remains the gold standard for the diagnosis of NASH and staging of fibrosis. In addition, there are no approved pharmacological treatments currently. Lifestyle modification remains the cornerstone of treatment. Team based multidisciplinary approach involving hepatologists, endocrinologists, exercise physiologist, dieticians, and cardiologists may lead to better outcomes. Recently, the American Association for the Study of Liver Diseases (AASLD) and European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) committees have made recommendations for the diagnosis and management of NAFLD in pediatric patients. This review focuses on current literature on epidemiology, natural history, pathogenesis along with summarizing the recent guidelines on diagnosis and treatment of pediatric NAFLD.

Risk factors for elevated liver enzymes during refeeding of severely malnourished patients with eating disorders: a retrospective cohort study

“…According to a previous report, some children with non-alcoholic fatty liver disease are at risk for developing nonalcoholic steatohepatitis [25]. Although there is a difference in clinical conditions between fatty liver caused by starvation and that by obesity, a similar pathogenetic mechanism is hypothesized [24].…”

Liver transplantation for nonalcoholic steatohepatitis in young patients

“…Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the obesity and metabolic syndrome epidemics and now affects up to 45% of adults and 10% of children in the United States . Nonalcoholic steatohepatitis (NASH) is the aggressive form of NAFLD that can progress to cirrhosis and end‐stage liver disease requiring liver transplantation (LT) . Recent adult data have shown that NASH is the third most common indication for LT in the United States and is expected to become the leading indication over the next 1–2 decades .…”

40 The Development of the Pediatric NAFLD Fibrosis Score (PNFS) to Predict the Presence of Advanced Fibrosis in Children With Nonalcoholic Fatty Liver Disease

“…NAFLD represents a disease spectrum that ranges from simple steatosis to non-alcoholic steatohepatitis (NASH), to advanced fibrosis and ultimately cirrhosis [24]. The presence and stage of fibrosis is considered an important factor in the prognosis of NAFLD and the prediction of the risk of developing cirrhosis [25].…”