Non-Alcoholic Fatty Liver and Metabolic Syndrome in Children: A Vicious Circle

Abstract

During the last decade, paediatricians have observed a dramatic increase of non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MS) in children. Furthermore, several lines of evidence have reported that a large part of children with NAFLD presents one or more traits of MS making plausible that, in the coming years, these subjects may present a rapid course of disease towards more severe cirrhosis and cardiovascular disease. Genetic susceptibility and the pressure of intrauterine environment and lifestyle are all crucial to activate molecular machinery that leads to development of NAFLD and MS in childhood. In this scenario, central obesity and consequent adipose tissue inflammation are critical to promote both MS-associated metabolic dysfunctions and NAFLD-related hepatic damage. An excessive dietary intake may in fact cause a specific lipid partitioning and induce metabolic stressors, which in turn promote insulin resistance and the release of several circulating factors. These molecules, on the one hand, trigger steatosis and the inflammatory response that characterize liver damage in NAFLD, and on the other hand contribute to the onset of other features of MS. This review provides an overview of current genetic, pathogenetic and clinical evidence of the vicious circle created by NAFLD and MS in children.

Nonalcoholic Fatty Liver Disease in Italian Children with Down Syndrome: Prevalence and Correlation with Obesity-Related Features

“…It is widely accepted that NAFLD has to be considered as an additional feature of metabolic syndrome in both adults and children. 44,45 Our study showed that the prevalence of NAFLD in both normal-weight children with DS (45%) and those who are overweight/obese (82%) is greater if compared with the European pediatric nonobese population (5.7%) or obese population (33%). 20 Moreover, we found at least one component of metabolic syndrome associated with children with DS who have NAFLD that exhibited a greater percentage of these variables respect to subject without NFLD.…”

Novel Insights in the Metabolic Syndrome in Childhood and Adolescence

“…Thus, white adipose tissue is in permanent crosstalk influencing other organ systems through the production of these adipocytokines [47]. Altered levels of adipocytokines have been demonstrated as a common feature not only in obesity, but also in NAFLD and MetS in children and adolescents [48, 49]. Apart from that, adipocytokines have been described to play a role in growth, reproduction, bone metabolism, immune response, cancer development, and many other important biological processes [48].…”

Asociación de la obesidad abdominal y alteraciones de la presión arterial con estrategias de afrontamiento a la carestía alimentaria en niños en edad escolar.

“…Una explicación que se ha propuesto para este fenómeno, es la diferencia en el consumo de alimentos hipercalóricos (particularmente jarabe de maíz de alta fructosa) los cuales pueden inducir el desarrollo de resistencia a la insulina desde etapas tempranas de la vida. (4,7,15,19) Acorde con lo anteriormente descrito se encontró que la obesidad abdominal se encuentra asociada con el consumo habitual de alimentos procesados (p<0.05 OR 2.2 IC95% 1.04-4.6), así como el de refrescos embotellados (p<0.01 OR 1.43, IC95%1.1-1.8).…”

“…Existe una carencia relativa de información respecto al comportamiento de las variables del síndrome metabólico en la población pediátrica. Ya se ha demostrado mediante estudios clínicos y anatomopatológicos que los correlatos del síndrome metabólico son identificables en edades tan tempranas como los tres años (8,14,15). Una de las situaciones que dificulta el adecuado estudio del síndrome metabólico en los niños es la ausencia de un estándar de diagnóstico universalmente aceptado.…”