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Emerging New Diagnostic Modalities and Therapies of Nonalcoholic Fatty Liver Disease
1Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, and the Department of Pediatrics, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, Mail Stop 78, Los Angeles, CA, 90027, USA. chlin@chla.usc.edu.
Insights
Pediatric nonalcoholic fatty liver disease (NAFLD) screening and diagnosis are improving with new noninvasive tests. However, effective treatments remain limited, emphasizing lifestyle changes while new therapies are developed.
Area of Science:
- Hepatology
- Pediatric Gastroenterology
- Metabolic Disorders
Background:
- Nonalcoholic fatty liver disease (NAFLD) is the primary cause of chronic liver disease in children.
- NAFLD prevalence is increasing globally in pediatric populations.
Purpose of the Study:
- To review recent advancements in screening, diagnosis, and treatment of pediatric NAFLD.
- To highlight emerging diagnostic tools and therapeutic strategies for NAFLD in children.
Main Methods:
- Review of current literature on pediatric NAFLD screening and diagnostic methods.
- Analysis of recent clinical trials and therapeutic approaches for pediatric NAFLD.
- Evaluation of noninvasive biomarkers and imaging techniques for NAFLD diagnosis.
Main Results:
- Alanine aminotransferase (ALT) is the preferred screening test; liver biopsy remains gold standard for nonalcoholic steatohepatitis (NASH).
- Noninvasive methods like MRI-PDFF and VCTE show promise for pediatric NAFLD diagnosis.
- Current therapeutic trials (vitamin E, metformin, cysteamine) show inconclusive results; lifestyle modification is key.
- Bariatric surgery is an option for adolescents with severe obesity; obeticholic acid shows potential in adults.
Conclusions:
- While diagnostic capabilities for pediatric NAFLD are advancing, effective treatments are still under development.
- Lifestyle interventions are crucial for managing pediatric NAFLD.
- Ongoing research and FDA guidance are paving the way for new therapeutic agents for NASH.
Purpose Of Review:
Nonalcoholic fatty liver disease (NAFLD) has emerged as the leading cause of chronic liver disease in both adults and children. In this article, we review recent developments in the screening, diagnosis, and treatment of pediatric NAFLD.
Recent Findings:
Although alanine aminotransferase (ALT) remains the best screening test for NAFLD in children, and liver biopsy is still required for the diagnosis of nonalcoholic steatohepatitis (NASH), other noninvasive biomarker/imaging studies (MRI-PDFF and VCTE) have emerged as diagnostic methods for pediatric NAFLD. Two large clinical therapeutic trials testing vitamin E, metformin, and cysteamine in pediatric NAFLD yielded mostly inconclusive results. Bariatric surgery has begun to be used in adolescents with severe obesity. An adult phase 2 study using obeticholic acid (OCA) to treat NASH patients with fibrosis showed some positive results. As we continue to await the first FDA-approved therapeutic agent for NASH, lifestyle change remains the main modality of treatment. Newer diagnostic and treatment modalities for pediatric NAFLD continue to be in development under FDA guidance.
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