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Overview of Pediatric Nonalcoholic Fatty Liver Disease: A Guide for General Practitioners
Asiya K Shakir1, Upma Suneja1, Kevin R Short2
1University of Oklahoma, Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition.
Insights
Pediatric nonalcoholic fatty liver disease (NAFLD) affects obese and Hispanic children, requiring screening between ages 9-11. Early diagnosis and lifestyle changes are crucial for managing this growing liver condition in children.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Public Health
Background:
- Nonalcoholic fatty liver disease (NAFLD) is a prevalent pediatric liver condition and a leading cause for liver transplantation in young adults.
- Early identification of risk factors, prevention, and diagnosis in childhood are critical for managing pediatric NAFLD.
- The incidence of NAFLD is increasing, necessitating updated clinical guidelines and screening protocols.
Purpose of the Study:
- To review updated recommendations for screening, diagnosis, and management of pediatric NAFLD.
- To assess the prevalence and impact of pediatric NAFLD within Oklahoma via participation in the TARGET-NASH study.
Main Methods:
- Review of current guidelines from the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN).
- Analysis of clinical approaches and data from the multi-center TARGET-NASH collaboration.
- Evaluation of screening criteria and diagnostic standards for pediatric NAFLD.
Main Results:
- Obese and Hispanic children are identified as the highest-risk groups for pediatric NAFLD.
- Screening for NAFLD with alanine aminotransferase (ALT) is recommended for children aged 9-11 with a BMI above the 95th percentile.
- Liver biopsy remains the gold standard for NAFLD diagnosis, with lifestyle modification as the primary treatment.
Conclusions:
- Screening for NAFLD using serum ALT is advised for obese children, particularly those of Hispanic ethnicity or with a family history, between ages 9 and 11.
- Pediatric patients with ALT levels more than double the normal limit for over three months require referral to pediatric hepatology.
- Prompt evaluation and intervention are essential for children at risk or diagnosed with NAFLD.
Importance:
Nonalcoholic fatty liver disease (NAFLD) is rapidly evolving into one of the most common pediatric liver diseases and currently is the most common cause for liver transplantation in young adults. Therefore, early recognition of risk factors, disease prevention, and diagnosis during childhood is paramount for effective management.
Objective:
The primary objective of this review is to discuss updated recommendations for screening, diagnosis and management of NAFLD. The secondary objective is to review the extent and impact of pediatric NAFLD in Oklahoma through our center's participation in a multi-center prospective study.
Evidence Review:
We reviewed updated guidelines from the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), the approach used in our clinic and data from a multi-center collaboration on NAFLD, known as TARGET-NASH.
Findings:
Our review highlights that obese and Hispanic children are at greatest risk for developing NAFLD. Screening with ALT should be considered between ages 9-11 years for children with BMI more than the 95th percentile. Liver biopsy is the gold standard for diagnosis of NAFLD and currently lifestyle modification is the only effective therapy for management of NAFLD.
Conclusion And Relevance:
All obese children, especially those who are Hispanics or have a family history of NAFLD should be considered for screening with serum ALT between the ages of 9 and 11 years. Children with ALT values that are elevated more than twice the upper limit of normal for more than 3 months must be referred to pediatric hepatology for timely evaluation.
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