Paediatric non‐alcoholic fatty liver disease: an overview

Abstract

Non-alcoholic fatty liver disease (NAFLD) is a progressive disease that encompasses a spectrum of liver diseases, ranging from simple steatosis to non-alcoholic steatohepatitis (NASH). Data related to survival in children are scarce, but these data firmly associate NAFLD with higher risks of hepatic and non-hepatic morbidities and mortalities compared with the general population. More recently, the association between NAFLD and cardiovascular disease among children has increasingly been recognized. Given that obesity is a major risk factor for the disease, paediatric NAFLD is becoming a global issue, paralleling the dramatic rise in obesity worldwide. NASH, which is more common in obese children, has the potential to advance to liver fibrosis and failure. It is unclear why certain patients undergo such transformation but this susceptibility is likely related to an interaction between a genetically susceptible host and the surrounding environment. Currently, treatment is largely conservative and includes lifestyle modification, attainable through healthy weight reduction via diet and exercise. In this review, current knowledge about NAFLD in children is summarized. This review aims to increase the awareness of the medical community about a hidden public health issue and to identify current gaps in the literature while providing directions for future research.

Effect of the patatin‐like phospholipase domain containing 3 gene (PNPLA3) I148M polymorphism on the risk and severity of nonalcoholic fatty liver disease and metabolic syndromes: A meta‐analysis of paediatric and adolescent individuals

“…The discrepancies between adult NAFLD and the corresponding paediatric and adolescent type were recognized and could be attributed to confounders of disease, including dietary habits, lifestyle routines, disease duration, and comorbidities. These factors could play less of a role in early‐onset disease, which is more vulnerable to variation in the genetic constitution . Thus, after finding the significant association between the I148M polymorphism and NAFLD in the general population, this exploratory meta‐analysis was performed to provide a unique perspective on the accumulated evidence regarding the magnitude of the risk and severity of early‐onset NAFLD and MetSs.…”

Hepatic fat content and bone mineral density in children with overweight/obesity

“…8 The clinical burden of NAFLD is not limited to liver-associated morbidity and mortality, but NAFLD is also associated with elevated risk to develop type 2 diabetes and cardiovascular disease. 9 Preliminary evidence suggests a link between NAFLD and decreased BMD. 10,11 However, the majority of the studies have been conducted in Asian populations, and in adults 12 and adolescents, 13,14 while the information in children is scarce.…”

Pediatric Cytochrome P450 Activity Alterations in Nonalcoholic Steatohepatitis

“…Many studies have demonstrated that the entire spectrum of NAFLD also occurs during childhood (Molleston et al, 2002;Kleiner and Makhlouf, 2016). Concurrent with childhood obesity, NAFLD has developed into a serious concern in pediatric clinical practice and has become a significant health burden in adolescence (AlKhater, 2015). An autopsy-based study estimated the overall prevalence of NAFLD in the American pediatric population at 9.6%, which increased to 17.3% in adolescents from 15 to 19 years old (Schwimmer et al, 2006).…”