Progression of Fatty Liver Disease in Children Receiving Standard of Care Lifestyle Advice

Pharmacological, Endoscopic, Metabolic, and Surgical Procedures for Nonalcoholic Fatty Liver Disease

“…For patients with nonalcoholic fatty liver disease (NAFLD), first‐line treatment remains lifestyle interventions to improve diet and activity and to reduce excess adiposity. Losing weight correlates with histological improvement in both children and adults with NAFLD 1,2 . However, many patients face challenges in implementing and maintaining the required lifestyle changes.…”

“…However, many patients face challenges in implementing and maintaining the required lifestyle changes. In most studies, less than half achieve resolution of nonalcoholic steatohepatitis (NASH), and even fewer resolve NAFLD completely 1,2 . When lifestyle interventions alone are insufficient, adjunctive treatment may include pharmacological or metabolic bariatric procedures, particularly in patients with progressive fibrosis.…”

“…The paucity of pediatric studies is in part due to uncertain clinical outcomes of youth‐onset NASH, the enhanced need to ensure safety and likely benefit, and the invasive nature of liver biopsy. However, a recent analysis of children receiving standard of care lifestyle advice and placebo showed that although half improved in some histological features of NAFLD, one‐third progressed in NASH or fibrosis severity within a 2‐year period of follow‐up and 5% experienced development of type 2 diabetes 2 . In addition, the rate of young adults with end‐stage liver disease is escalating, further highlighting the need to identify effective and safe therapies for youth‐onset NASH.…”

The relationship between excessive dietary fructose consumption and paediatric fatty liver disease

“…Some of these components are also present in lean adolescents with suspected NAFLD, suggesting that metabolic derangement, even outside of the context of obesity, may be important in disease pathogenesis 11 . A recent prospective study in children with NAFLD receiving only standard‐of‐care lifestyle counselling reported that >30% of children developed NASH and/or experienced worsening fibrosis within 2 years 12 . Increasing obesity and higher baseline levels of ALT (alanine aminotransferase), AST (aspartate aminotransferase), GGT (gamma‐glutamyl transferase), as well as total and LDL cholesterol (LDLC) were associated with progression to NASH, while progression in fibrosis was associated with white race, incident type 2 diabetes (T2D), and increasing ALT, GGT, and glycated haemoglobin (HbA1c).…”

Biomarkers in Fatty Liver Disease—Here is the Skinny

“…Xanthakos et al found that 18% of children with hepatosteatosis progress to steatohepatitis, whereas 11% progress to steatosis and fibrosis. 17 Therefore, although there is potential in those with steatosis to advance to fibrosis, disease does not always progress. Those who develop fibrosis may represent an extreme phenotype of disease, especially in children.…”