Nonalcoholic fatty liver disease in the pediatric population: a review

Nonalcoholic fatty liver disease is a common condition that may progress to end stage liver disease. It is closely associated with obesity and insulin resistance, two conditions whose prevalence is increasing dramatically in children. This could potentially make nonalcoholic fatty liver disease the most common liver disease in the pediatric population. This review will focus on the current knowledge regarding the epidemiology, clinical presentation, diagnosis, pathogenesis, and management of nonalcoholic fatty liver disease in children.

Recent studies suggest that nonalcoholic fatty liver disease is an increasingly recognized condition during childhood, especially in overweight and obese children. Although limited information is currently available on the natural history of the disease in the pediatric population, few cross-sectional studies and a single longitudinal cohort study with follow up data up to 16 years, showed that as in adults, nonalcoholic fatty liver disease in children may have a progressive clinical course with the development of cirrhosis. Emerging data from small pilot studies suggest weight loss through lifestyle modifications as well as insulin sensitizing and antioxidant medications may be of benefit. Moreover, recent advances in the understanding of nonalcoholic fatty liver disease pathogenesis may result in novel therapeutic targets to treat this disease.

Nonalcoholic fatty liver disease is probably the most common form of chronic liver disease in children and may continue to rise with the increasing prevalence of childhood obesity and metabolic syndrome. Recent studies have provided new insights regarding this condition in children. There is still much progress to be made in terms of the description of pediatric nonalcoholic fatty liver disease, its demographics, pathogenesis, and treatment as well as natural history and long-term prognosis.