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Steatohepatitis in children
1Division of Gastroenterology and Nutrition, Room 8267, Black Wing, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
Insights
Non-alcoholic fatty liver disease (NAFLD) is increasingly recognized in children, often linked to obesity. Early diagnosis and lifestyle changes are crucial for managing this growing childhood liver concern.
Area of Science:
- Pediatric Hepatology
- Metabolic Disorders
- Gastroenterology
Background:
- Non-alcoholic fatty liver disease (NAFLD) is increasingly prevalent in children, challenging its prior perception as a rare condition.
- Childhood obesity is a significant driver for the rising incidence of pediatric NAFLD.
- NAFLD in children can manifest early, with males predominantly affected, and may progress to fibrosis and cirrhosis.
Purpose of the Study:
- To highlight the growing significance of NAFLD in pediatric populations.
- To outline current diagnostic and management strategies for childhood NAFLD.
- To emphasize the importance of excluding other liver pathologies and metabolic conditions.
Main Methods:
- Review of current literature and clinical observations regarding pediatric NAFLD.
- Discussion of diagnostic criteria and biopsy findings in affected children.
- Analysis of treatment approaches, including lifestyle modifications and potential adjunctive therapies.
Main Results:
- Pediatric NAFLD is a significant cause of chronic liver disease in children, often associated with obesity.
- Fibrosis is commonly observed in liver biopsies of children with NAFLD, with cirrhosis also reported.
- Effective management involves weight reduction, exercise, and consideration of vitamin E therapy.
Conclusions:
- NAFLD is a critical pediatric liver disease requiring increased clinical attention.
- Exclusion of drug-induced liver injury, genetic/metabolic diseases (e.g., Wilson's disease, cystic fibrosis), and viral hepatitis is essential for accurate diagnosis and treatment.
- Identification of underlying inherited conditions associated with hyperinsulinemia and insulin resistance is important for comprehensive care.
Abstract:
Steatohepatitis in children occurs in the childhood version of non-alcoholic fatty liver disease (NAFLD), as a result of hepatotoxicity and with certain genetic/metabolic diseases. Until recently, NAFLD was considered to be rare in children. It is now recognized as an important childhood liver disease, especially because childhood obesity is much more common. Children with NAFLD may present as young as 4 years old; males tend to predominate; fibrosis is often found on liver biopsy and cirrhosis has been reported. Treatment for childhood NAFLD currently consists of weight reduction plus regular aerobic exercise; vitamin E may be an effective adjunctive therapy. Drug hepatotoxicity and genetic/metabolic diseases that can cause fatty liver, such as Wilson's disease and cystic fibrosis, must be excluded since treatment is radically different. Other causes of chronic hepatitis, such as chronic viral hepatitis, must also be excluded. Multisystemic inherited diseases with hyperinsulinaemia plus insulin resistance may have NAFLD as hepatic involvement and should be identified.