The metabolic syndrome and nonalcoholic fatty liver disease in children.
OBJECTIVE
Nonalcoholic fatty liver disease (NAFLD) is increasingly prevalent in pediatric-age individuals, in parallel with increasing obesity, and can lead to liver inflammation, fibrosis, and even cirrhosis. NAFLD appears tightly linked with features of the metabolic syndrome (MetS). This review aims to reconsider the clinical presentation, laboratory and pathologic assessment, and treatment of NAFLD, with a focus on its relationship with the MetS.


RESULTS
NAFLD occurs with a high prevalence and severity in obese, insulin-resistant adolescents, especially Hispanic males. Pediatric NAFLD may improve with lifestyle therapy and agents that improve insulin sensitivity. In youth, NAFLD appears tightly correlated with components of the MetS, especially visceral fat, which appears to predict fibrosis as well as liver fat. In addition, noninvasive techniques such as transient elastography may help provide data on fibrosis in youth with NAFLD and avoid biopsy.


CONCLUSIONS
The close association between NAFLD and the MetS supports screening for other comorbidities associated with the MetS. Further research is urgently required to best identify effective therapies to prevent and treat NAFLD, but its close association with MetS argues for a focus on strategies designed to improve insulin resistance and components of the MetS.
Sundaram
Shikha S
SS
Division of Gastroenterology, Hepatology and Nutrition, University of Colorado Denver, Aurora, Colorado 80045, USA.
Zeitler
Phil
P
Nadeau
Kristen
K
D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005234:Fatty Liver / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008099:Liver / Q000473:pathology; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome