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Pediatric Nonalcoholic Fatty Liver Disease: the Rise of a Lethal Disease Among Mexican American Hispanic Children

Monica M Betancourt-Garcia1, Armando Arguelles2, Jorge Montes2

  • 1Doctors Hospital at Renaissance Health Care System, 5501 S McColl Rd., Edinburg, TX, 78539, USA. m.betancourt@dhr-rgv.com.

Obesity Surgery
|November 9, 2016
PubMed

Insights

Hispanic children face high rates of nonalcoholic fatty liver disease (NAFLD) due to obesity, genetic factors, and microbiome changes. Gastric bypass may offer a promising treatment for pediatric NAFLD.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Obesity Medicine

Background:

  • Hispanic children of Mexican origin exhibit a high incidence of nonalcoholic fatty liver disease (NAFLD).
  • Susceptibility is multifactorial, involving childhood obesity, PNPLA3 gene variants affecting lipid metabolism, and an altered gut microbiome potentially increasing endotoxins.
  • This combination may accelerate the progression from NAFLD to nonalcoholic steatohepatitis (NASH), cirrhosis, and early hepatocellular carcinoma.

Purpose of the Study:

  • To highlight the critical need for early detection and intervention in pediatric NAFLD.
  • To propose gastric bypass as a potential therapeutic strategy for predisposed children with NAFLD/NASH.

Main Methods:

  • This study is a review and proposal based on existing literature regarding NAFLD pathogenesis and bariatric surgery outcomes.
  • It synthesizes data on the impact of obesity, genetics (PNPLA3), and microbiome on NAFLD progression in pediatric populations.
  • It draws parallels with the established efficacy of gastric bypass in improving NAFLD/NASH in adults.

Main Results:

  • The convergence of obesity, genetic predisposition (PNPLA3), and dysbiosis contributes to severe liver disease in Hispanic children.
  • Nonalcoholic steatohepatitis (NASH) and its complications, including cirrhosis and hepatocellular carcinoma, can occur early in this population.
  • Gastric bypass has demonstrated success in adults for weight reduction, microbiome modulation, and NAFLD/NASH improvement.

Conclusions:

  • Early identification and management of hepatic changes in pediatric NAFLD are crucial.
  • Gastric bypass surgery warrants investigation as a potential treatment for pediatric NAFLD/NASH in carefully selected, predisposed individuals.
  • Further clinical trials are needed to evaluate the safety and efficacy of gastric bypass in this pediatric cohort.

Keywords:
EpidemiologyGut microbiomeHepatic steatosisMexican AmericanPNPLA3Pediatric nonalcoholic fatty liver disease

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