Paediatric non-alcoholic fatty liver disease: a practical overview for non-specialists

Abstract

Non-alcoholic fatty liver disease (NAFLD) is the most common paediatric liver disease with a prevalence of almost 10%; therefore, the majority of affected patients are under the care of general practitioners and non-specialists. The condition is caused by central obesity with insulin resistance with additional factors influencing inflammatory activity (steatohepatitis). Ongoing inflammation leads to fibrosis and end-stage liver disease, though this will usually occur after children have transitioned into adult care. However, their main morbidity and mortality is from type 2 diabetes and complications of atherosclerosis. The minority of children undergo biopsy but currently there is no other method to accurately assess the stage of disease. Management is focused at weight loss through a combination of diet and exercise. Here, we present a current review of paediatric NAFLD aimed at non-specialists, with practice points for implementation.

Obesity, related diseases and their relationship with vitamin D deficiency in adolescents

“…According to Mann et al (45), non-alcoholic fatty liver disease (NAFLD) affects around 10% of the pediatric population (45,46). The minority of children undergo biopsy but currently there is no other method to accurately assess the stage of disease.…”

Enfermedad hepática grasa no alcohólica: una nueva epidemia en la edad pediátrica

“…Sin embargo, la ALT no es ni sensible ni específica de NAFLD, ya que los valores pueden fluctuar y hasta ser normales en pacientes con NAFLD, NASH y aun cirrosis. 8,12,17 La biopsia hepática se considera el patrón para el diagnóstico de NAFLD y puede distinguir la esteatosis simple de la NASH, definir el grado de fibrosis y colaborar en el diagnóstico diferencial. No obstante, es un procedimiento invasivo, relativamente costoso y asociado a un número infrecuente pero significativo de complicaciones.…”

“…Tiene mayor especificidad que la ultrasonografía, pero no se aconseja su uso rutinario, debido a la exposición a radiación que genera. 12,[15][16][17][18] La resonancia nuclear magnética (RNM) puede proporcionar una medida cuantitativa de la grasa infiltrada, aunque existen escasos estudios vinculados con su utilización en l a p o b l a c i ó n p e d i á t r i c a . P u e d e d e t e c t a r hasta un 3% de esteatosis y está sometida a menor variabilidad, lo que le otorga mayor sensibilidad que la ultrasonografía.…”

Non-alcoholic fatty liver disease: a new epidemic in children

“…A CT is more specific than an ultrasound, but it is not recommended for routine use because of radiation exposure. 12,[15][16][17][18] A magnetic resonance imaging (MRI) may provide a quantitative measure of infiltrated fat, but few studies have investigated its use in the pediatric population. An MRI may detect up to 3% of steatosis and has a lower variability, making it more sensitive than an ultrasound.…”

“…However, an ALT finding is not sensitive or specific to NAFLD, given that its value may fluctuate and even be normal in patients with NAFLD, NASH, or cirrhosis. 8,12,17 A liver biopsy is the gold standard for NAFLD diagnosis and helps to differentiate simple steatosis from NASH, establish the degree of fibrosis, and make a differential diagnosis. However, it is an invasive, relatively costly procedure associated with an uncommon though significant number of complications.…”