Review article: epidemiology, pathogenesis and potential treatments of paediatric non-alcoholic fatty liver disease.
BACKGROUND
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of paediatric liver disease. Similar to NAFLD in adults, NAFLD in children is associated with obesity and insulin resistance and requires liver histology for diagnosis and staging. However, significant histological differences exist between adult and paediatric NAFLD to warrant caution in extrapolation of adult data.


OBJECTIVE
To review the available data on the epidemiology, pathogenesis, diagnosis and treatment of paediatric NAFLD.


METHODS
Relevant articles were identified by Medline searches using the keywords: nonalcoholic fatty liver disease, steatohepatitis, obesity and children.


RESULTS
The rise in childhood obesity has been accompanied by an increase in paediatric NAFLD. Age, gender and race/ethnicity are significant determinants of risk, and sex hormones, insulin sensitivity and adipocytokines are implicated in the pathogenesis of paediatric NAFLD. There is no consensus for treatment of NAFLD; however, data suggest that diet, exercise and some pharmacological therapies may be of benefit.


CONCLUSIONS
To evaluate and effectively treat paediatric NAFLD, the pathophysiology and natural history of the disease should be clarified and non-invasive methods for screening, diagnosis, and longitudinal assessment developed. Randomized, controlled, double-blind trials of pharmacological therapies in children with biopsy-proven disease are necessary.
Barshop
N J
NJ
Department of Pediatrics, University of California, San Diego, CA, USA.
Sirlin
C B
CB
Schwimmer
J B
JB
Lavine
J E
JE
D000293:Adolescent; D000328:Adult; D000975:Antioxidants / Q000627:therapeutic use; D015415:Biomarkers / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005081:Exercise Therapy; D005234:Fatty Liver / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005260:Female; D022781:Hepatocytes / Q000473:pathology; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D009765:Obesity / Q000150:complications / Q000178:diet therapy; D018384:Oxidative Stress; D016032:Randomized Controlled Trials as Topic; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use; D015431:Weight Loss
D000975:Antioxidants; D015415:Biomarkers; D014580:Ursodeoxycholic Acid