Screening for non-alcoholic fatty liver disease in children: do guidelines provide enough guidance?
B G P Koot1, V Nobili2,3
1Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
Insights
Screening for childhood non-alcoholic fatty liver disease (NAFLD) is recommended but lacks consistent guidelines on who and how to screen. Further research is needed for accurate tools and cost-effectiveness.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Public Health
Background:
- Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver condition in children globally.
- Its high incidence and associated health risks underscore the need for effective screening strategies.
- Current screening practices for pediatric NAFLD are widespread but lack uniformity.
Purpose of the Study:
- To systematically review existing recommendations for screening non-alcoholic fatty liver disease in pediatric populations.
- To identify and discuss current challenges and areas of controversy in pediatric NAFLD screening.
Main Methods:
- A comprehensive review of major pediatric obesity and NAFLD guidelines was conducted.
- An overview of the current literature addressing open questions and controversies in the field was provided.
Main Results:
- Most pediatric NAFLD and obesity guidelines advocate for screening.
- Significant heterogeneity exists among guidelines regarding screening targets and practical implementation.
- Screening remains controversial due to limitations in accuracy of current tools, predictive knowledge of disease progression, and cost-effectiveness data.
Conclusions:
- Existing guidelines offer limited practical direction for implementing pediatric NAFLD screening.
- The controversial nature of screening stems from unmet criteria for ideal screening programs.
- Consensus on the optimal use of existing screening tools is required, alongside research into novel accurate tools, NAFLD natural history, and cost-effective screening strategies.
Background:
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the industrialized world in children. Its high prevalence and important health risks make NAFLD highly suitable for screening. In practice, screening is widely, albeit not consistently, performed.
Aim:
To review the recommendations on screening for NAFLD in children.
Method:
Recommendations on screening were reviewed from major paediatric obesity guidelines and NAFLD guidelines. A literature overview is provided on open questions and controversies.
Results:
Screening for NAFLD is advocated in all obesity and most NAFLD guidelines. Guidelines are not uniform in whom to screen, and most guidelines do not specify how screening should be performed in practice. Screening for NAFLD remains controversial, due to lack of a highly accurate screening tool, limited knowledge to predict the natural course of NAFLD and limited data on its cost effectiveness.
Conclusions:
Guidelines provide little guidance on how screening should be performed. Screening for NAFLD remains controversial because not all conditions for screening are fully met. Consensus is needed on the optimal use of currently available screening tools. Research should focus on new accurate screening tool, the natural history of NAFLD and the cost effectiveness of different screening strategies in children.
More Related Videos
04:14Incorporation of a Survivable Liver Biopsy Procedure in Mice to Assess Non-alcoholic Steatohepatitis NASH Resolution
Published on: April 16, 2019
07:03Author Spotlight: Establishing MASLD Cell Models for Investigating Disease Mechanisms and the Lipid-Lowering Effects of Koumiss
Published on: July 19, 2024
Related Concept Videos
01:25Ultrasound II: Endoscopic Ultrasound and FibroScan
Endoscopic Ultrasound (EUS):
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:26Diseases of the Liver and Gallbladder
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...