<p>Pediatric non-alcoholic fatty liver disease: current perspectives on diagnosis and management</p>

Abstract

Non-alcoholic fatty liver disease (NAFLD) represents the most common cause of chronic liver disease in childhood. To date, the “multiple-hit” hypothesis is largely recognized as an explanation of NAFLD pathogenesis and progression. Obesity and features of the metabolic syndrome have been closely linked to NAFLD development. Due to the increased prevalence of obesity worldwide, NAFLD has reached epidemic proportions over time. Given its unfavorable cardiometabolic burden (such as cardiovascular and metabolic consequences), it represents a worrying phenomenon needing a more comprehensive and successful management. Laboratory tests and classical imaging techniques play a pivotal role in NAFLD diagnosis, but novel noninvasive alternative methods to diagnose and monitor NAFLD have been investigated. Currently, lifestyle modifications remain the mainstay treatment, although its efficacy is poor because of the lack of compliance. Pediatric research is focusing on multiple alternative treatments targeting the main pathogenic factors such as insulin-resistance, dyslipidemia, gut-liver axis and microbiota, oxidative stress, and proinflammatory pathways. Results from these studies are promising but larger validation is needed. Innovative therapeutic approaches might add an important piece in the complex knowledge of pediatric NAFLD. We aimed to summarize recent insights into NAFLD diagnosis and treatment in children, with a focus on possible future perspectives in pediatric research.

Crosstalk Between Liver Macrophages and Surrounding Cells in Nonalcoholic Steatohepatitis

“…Nonalcoholic fatty liver disease (NAFLD), an increasingly common liver disease worldwide, ranges from relatively benign NAFL to nonalcoholic steatohepatitis (NASH) (1,2). NASH is strongly associated with progressive liver fibrosis and has further become a major cause of cirrhosis and liver cancer (3).…”

Bifidobacterium breve CNCM I-4035, Lactobacillus paracasei CNCM I-4034 and Lactobacillus rhamnosus CNCM I-4036 Modulate Macrophage Gene Expression and Ameliorate Damage Markers in the Liver of Zucker-Leprfa/fa Rats

“…Non-alcoholic fatty liver disease (NAFLD) has reached pandemic proportions worldwide [ 1 ]. This disease is characterized by fat accumulation in the form of micro and macrovacuoles of lipids in hepatocytes [ 2 ] and may progress from simple steatosis, non-alcoholic steatohepatitis to fibrosis, advanced cirrhosis and hepatocarcinoma [ 3 ].…”

MAFLD in Obese Children: A Challenging Definition

“…More, hepatic steatosis was diagnosed by liver sonography instead of by biopsy, though better reflecting daily clinical practice, in which this latter is not used for the diagnosis of fatty liver disease. On the other hand, additional tools for NAFLD diagnosis in overweight/obese children have been recently identified [ 25 , 26 ]. In addition to the classical techniques such as computed tomography or magnetic resonance, several attractive approaches in this field have been proposed over the past years [ 26 ].…”

“…On the other hand, additional tools for NAFLD diagnosis in overweight/obese children have been recently identified [ 25 , 26 ]. In addition to the classical techniques such as computed tomography or magnetic resonance, several attractive approaches in this field have been proposed over the past years [ 26 ]. For instance, controlled attenuation parameter and transient elastography represent further noninvasive tools for NAFLD assessment [ 25 , 26 ].…”

“…In addition to the classical techniques such as computed tomography or magnetic resonance, several attractive approaches in this field have been proposed over the past years [ 26 ]. For instance, controlled attenuation parameter and transient elastography represent further noninvasive tools for NAFLD assessment [ 25 , 26 ]. Besides, researchers have also suggested distinct biomarkers (e.g., fetuin A, chemerin, and cathepsin D) or predictive scores (including the Pediatric NAFLD score) for pediatric NAFLD diagnosis [ 26 ].…”