Non-alcoholic fatty liver infiltration in children: an underdiagnosed evolving disease
Flora Tzifi1,2, Andreas Fretzayas3, George Chrousos4
1First Department of Pediatrics, Division of Endocrinology, Diabetes and Metabolism, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece. fltzifi@med.uoa.gr.
Insights
Non-alcoholic fatty liver disease (NAFLD) is a growing concern in children, often linked to obesity. Early detection and intervention are crucial for reversibility and preventing severe liver complications.
Area of Science:
- Hepatology
- Pediatric Gastroenterology
- Metabolic Disorders
Background:
- Non-alcoholic fatty liver disease (NAFLD) is the most prevalent liver condition, frequently underdiagnosed in children.
- Rising childhood obesity rates globally contribute significantly to the increasing incidence of pediatric NAFLD.
- The pathophysiology of NAFLD in children shares similarities with adults but presents unique age-related differences.
Purpose of the Study:
- To review current literature on NAFLD in pediatric populations.
- To highlight the diagnostic challenges and management strategies for childhood NAFLD.
- To emphasize the link between NAFLD, metabolic syndrome, and obesity in children.
Main Methods:
- Comprehensive literature review of studies on pediatric NAFLD.
- Analysis of diagnostic approaches, including laboratory tests, imaging, and liver biopsy.
- Examination of the natural history and progression of NAFLD in children.
Main Results:
- Pediatric NAFLD is an evolving disease and a key component of metabolic syndrome.
- Unlike adults, children necessitate extensive laboratory workups to rule out other contributing pathologies.
- Liver biopsy remains the definitive diagnostic tool, despite advancements in non-invasive methods.
Conclusions:
- Early diagnosis and intervention, including obesity prevention, are vital as pediatric NAFLD is reversible in its early stages.
- Untreated NAFLD can advance to non-alcoholic steatohepatitis (NASH), liver fibrosis, and potentially fatal liver failure.
- Pediatricians must actively screen high-risk children and collaborate with specialists for timely management of NAFLD.
Abstract:
Non-alcoholic fatty liver disease (NAFLD) constitutes the most common liver disease, one that is still underdiagnosed in pediatric populations (as well as in the general population), this due to the progressive increase in childhood obesity observed both in developed and developing countries during the last few decades. The pathophysiology of the disease has not been thoroughly clarified yet. The condition displays common pathways in adults and children; however, there are age-related differences. Unlike adults, children with NAFLD require extensive laboratory analysis, because underlying pathologies other than obesity may contribute to the evolution of the disease. Despite the presence of several serum markers and imaging techniques that contribute to NAFLD diagnosis, liver biopsy remains the gold standard diagnostic procedure. Early intervention and obesity prevention are mandatory, as NAFLD is reversible at an early stage. If left undiagnosed and untreated, NAFLD can progress to steatohepatitis (NASH) and subsequent liver failure, a potentially lethal complication. Of note, there are no treatment options when advanced liver fibrosis occurs. This review summarizes literature data on NAFLD in childhood indicating that this is an evolving disease and a significant component of the metabolic syndrome. Pediatricians should be aware of this entity, screening children at high risk and providing appropriate early management, in collaboration with pediatric subspecialists.
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