Therapeutic options in pediatric non alcoholic fatty liver disease: current status and future directions.
The epidemics of overweight and obesity has resulted in a significant increase of non alcoholic fatty liver disease (NAFLD), a potentially progressive condition. Currently, obesity related hepatopathy represents therefore the main cause of pediatric chronic liver disease. The first choice treatment at all ages is weight loss and/or lifestyle changes, however compliance is very poor and a pharmacological approach has become necessary. In the present article we present a systematic literature review focusing on established pediatric NALFD drugs (ursodeoxycholic acid, insulin sensitizers, and antioxidants) and on innovative therapeutic options as well.Regarding the former ones, a pediatric pilot study highlighted that ursodeoxycholic acid is not efficient on transaminases levels and bright liver. Similarly, a recent large scale, multicenter randomized clinical trial (TONIC study) showed that also insulin sensitizers and antioxidant vitamin E have scarce effects on serum transaminase levels. Among a large series of novel therapeutic approaches acting on recently proposed different pathomechanisms, probiotics seem hitherto the most interesting and reasonable option for their safety and tolerability. Toll-like receptors modifiers, Pentoxifylline, and Farnesoid X receptors agonists have been still poorly investigated, and will need further studies before becoming possible promising innovative therapeutic strategies.
Medical School of the University of Salerno, Salerno, Italy. pvajro@unisa.it
Pietro
P
Vajro
Selvaggia
S
Lenta
Claudio
C
Pignata
Mariacarolina
M
Salerno
Roberta
R
D'Aniello
Ida
I
De Micco
Giulia
G
Paolella
Giancarlo
G
Parenti
D000975:Antioxidants / Q000627:therapeutic use; D050110:Bariatric Surgery; D002648:Child; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005234:Fatty Liver / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008019:Life Style; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D050177:Overweight / Q000150:complications / Q000453:epidemiology; D056692:Prebiotics; D019936:Probiotics / Q000627:therapeutic use; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use; D015431:Weight Loss
D000975:Antioxidants; D002756:Cholagogues and Choleretics; D015525:Fatty Acids, Omega-3; D007004:Hypoglycemic Agents; D056692:Prebiotics; D014580:Ursodeoxycholic Acid