Nonalcoholic fatty liver disease in children

Mencin, Ali A.; Lavine, Joel E.

doi:10.1097/mco.0b013e328342baec

Cited by 66 publications

(69 citation statements)

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“…Liver involvement varies in severity from asymptomatic steatosis to nonalcoholic steatohepatitis (NASH) with inflammation to advanced fibrosis with cirrhosis, and can lead to hepatocellular carcinoma. Intrahepatic fat accumulation is thought to be secondary to insulin resistance, which in turn leads to macrovascular hepatic steatosis (38). Diagnosis is challenging as a liver biopsy is required.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…NAFLD is the most common cause of liver disease in children with a recent rise in its incidence that correlates with the increase in obesity prevalence among children and adolescents (38). Liver involvement varies in severity from asymptomatic steatosis to nonalcoholic steatohepatitis (NASH) with inflammation to advanced fibrosis with cirrhosis, and can lead to hepatocellular carcinoma.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Diagnosis is challenging as a liver biopsy is required. However, noninvasive measurement of biochemical markers and ultrasonographic imaging of the liver may be helpful (38). (VI) Polycystic ovarian syndrome (PCOS): PCOS is characterized by hyperandrogenism and is commonly associated with obesity and insulin resistance in adolescent females.…”

Section: Clinical Featuresmentioning

confidence: 99%

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Metabolic syndrome in children and adolescents

2017

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Prevalence of metabolic syndrome in children and adolescents is increasing, in parallel with the increasing trends in obesity rates. Varying definitions of this syndrome have hindered the development of a consensus for the diagnostic criteria in the pediatric population. While pathogenesis of metabolic syndrome is not completely understood, insulin resistance and subsequent inflammation are thought to be among its main mechanistic underpinnings. Overweight and obesity are cardinal features, along with abnormal glucose metabolism, dyslipidemia, and hypertension. Other disorders associated with metabolic syndrome include fatty liver, polycystic ovarian syndrome (PCOS), and pro-inflammatory states. Prevention and management of this condition can be accomplished with lifestyle modifications, behavioral interventions, pharmacological and surgical interventions as needed.

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Section: Clinical Featuresmentioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

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Metabolic syndrome in children and adolescents

2017

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“…The prevalence of NAFLD in the pediatric population is estimated to be 3 % and may increase with age. In pediatric NAFLD patients, genetic testing may be considered [26][27][28][29].…”

Section: Epidemiologymentioning

confidence: 99%

Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

et al. 2015

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Nonalcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease in industrialized countries worldwide, and has become a serious public health issue not only in Western countries but also in many Asian countries including Japan. Within the wide spectrum of NAFLD, nonalcoholic steatohepatitis (NASH) is a progressive form of disease, which often develops into liver cirrhosis and increases the risk of hepatocellular carcinoma. In turn, a large proportion of NAFLD/NASH is the liver manifestation of metabolic syndrome, suggesting that NAFLD/NASH plays a key role in the pathogenesis of systemic atherosclerotic diseases. Currently, a definite diagnosis of NASH requires liver biopsy, though various noninvasive measures are under development. The mainstays of prevention and treatment of NAFLD/NASH include dietary restriction and exercise; however, pharmacological approaches are often necessary.Currently, vitamin E and thiazolidinedione derivatives are the most evidence-based therapeutic options, although the clinical evidence for long-term efficacy and safety is limited. This practice guideline for NAFLD/NASH, established by the Japanese Society of Gastroenterology in cooperation with The Japan Society of Hepatology, covers lines of clinical evidence reported internationally in the period starting from 1983 to January 2012, and each clinical question was evaluated using the GRADE system. Based on the primary release of the full version in Japanese, this English summary provides the core essentials of this clinical practice guideline comprising the definition, diagnosis, and current therapeutic recommendations for NAFLD/NASH in Japan.

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“…1,2 Inflammation and cellular injury are often indicated by elevations in liver enzymes, particularly alanine aminotransferase (ALT). [3][4][5] Pediatric NAFLD has evolved into a serious public health issue, affecting between 7% to 17% of adolescents.…”

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confidence: 99%

Ethnic Differences in the Link Between Insulin Resistance and Elevated ALT

2013

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Evaluating for elevations in alanine aminotransferase (ALT) is a common screening test for the presence of nonalcoholic fatty liver disease (NAFLD). NAFLD is less common among non-Hispanic blacks. Better predictors of NAFLD are needed to identify individuals in most need of screening. WHAT THIS STUDY ADDS:Relative to other ethnicities, metabolic syndrome and insulin resistance performed poorly at identifying non-Hispanic black adolescents with ALT elevations. The presence of metabolic syndrome may therefore not be an adequate trigger for NAFLD screening. Triglyceride elevations performed similarly between groups in identifying ALT elevations. abstract BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) exhibits tight links with insulin resistance (IR) and the metabolic syndrome (MetS), a cluster of cardiovascular risk factors. Compared with non-Hispanic whites, non-Hispanic black adolescents have more IR but a lower prevalence of NAFLD and MetS. Our hypothesis was that IR would be a better predictor of alanine aminotransferase (ALT) elevations than is MetS among non-Hispanic blacks. METHODS:We analyzed data from 4124 adolescents aged 12 to 19 years in the 1999 to 2010 NHANES, using unexplained elevations in ALT (.30 U/L) to characterize presumed NAFLD and using a pediatric adaptation of the Adult Treatment Panel III definition of MetS. RESULTS:Prevalence of elevated ALT varied by race/ethnicity (Hispanics 13.7%, non-Hispanic white 8.6%, non-Hispanic blacks 5.4%, P , .0001). Among non-Hispanic whites and Hispanics, a classification of MetS performed well in identifying adolescents with elevated ALT (odds ratios [ORs] 9.53 and 5.56, respectively), as did MetS-related indices. However, among non-Hispanic blacks, the association between MetS and ALT elevations was smaller in magnitude and technically nonsignificant (OR = 3.24, P = .051). Furthermore, among non-Hispanic blacks, the presence of IR and elevated waist circumference performed more poorly at identifying ALT elevations (ORs 3.93 and 2.28, respectively: significantly smaller than ORs for non-Hispanic whites, P , .05), with triglyceride elevations being a better predictor (OR = 4.44).CONCLUSIONS: Non-Hispanic black adolescents exhibit a lower relationship between IR and elevated ALT, supporting racial/ethnic differences in the link between MetS and NAFLD. These data may have implications regarding triggers for screening for NAFLD among nonHispanic black adolescents, focusing particularly on those with triglyceride elevations. Pediatrics 2013;132:e718-e726 Drs DeBoer, Wiener, and Barnes were involved in the design, interpretation, and write-up of the study; and Dr Gurka was involved in the design, analysis, interpretation, and write-up of the study. All authors approved the final manuscript as submitted.www.pediatrics.org/cgi

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Nonalcoholic fatty liver disease in children

Cited by 66 publications

References 0 publications

Metabolic syndrome in children and adolescents

Metabolic syndrome in children and adolescents

Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

Ethnic Differences in the Link Between Insulin Resistance and Elevated ALT

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