Nonalcoholic Fatty liver disease/non-alcoholic steatohepatitis in childhood: endocrine-metabolic "mal-programming".
BACKGROUND
Nonalcoholic Fatty Liver Disease (NAFLD) is the major chronic liver disease in the pediatric population. NAFLD includes a broad spectrum of abnormalities (inflammation, fibrosis and cirrhosis), ranging from accumulation of fat (also known as steatosis) towards non-alcoholic steatohepatitis (NASH). The development of NAFLD in children is significantly increased.


METHODS
A literature search of electronic databases was undertaken for the major studies published from 1998 to today. The databases searched were: PubMed, EMBASE, Orphanet, Midline and Cochrane Library. We used the key words: "non-alcoholic fatty liver disease, children, non-alcoholic steatohepatitis and fatty liver".


RESULTS
NAFLD/NASH is probably promoted by "multiple parallel hits": environmental and genetic factors, systemic immunological disorders (oxidative stress, persistent-low grade of inflammation) as well as obesity and metabolic alterations (insulin resistance and metabolic syndrome). However its exact cause still underdiagnosed and unknown.


CONCLUSIONS
Pediatric NAFLD/NASH is emerging problem. Longitudinal follow-up studies, unfortunately still insufficient, are needed to better understand the natural history and outcome of NAFLD in children. This review focuses on the current knowledge regarding the epidemiology, pathogenesis, environmental, genetic and metabolic factors of disease. The review also highlights the importance of studying the underlying mechanisms of pediatric NAFLD and the need for complete and personalized approach in the management of NAFLD/NASH.
Department of Pediatric Sciences, Genetics and Pediatric Immunology Unit, University of Messina, Messina, Italy.
Sara
S
Manti
Department of Pediatric Sciences, Genetics and Pediatric Immunology Unit, University of Messina, Messina, Italy.
Claudio
C
Romano
Department of Pediatric Sciences, Genetics and Pediatric Immunology Unit, University of Messina, Messina, Italy.
Valeria
V
Chirico
Department of Pediatric Sciences, Genetics and Pediatric Immunology Unit, University of Messina, Messina, Italy.
Martina
M
Filippelli
Department of Pediatric Sciences, Genetics and Pediatric Immunology Unit, University of Messina, Messina, Italy.
Caterina
C
Cuppari
Department of Pediatric Sciences, Genetics and Pediatric Immunology Unit, University of Messina, Messina, Italy.
Italia
I
Loddo
Department of Pediatric Sciences, Genetics and Pediatric Immunology Unit, University of Messina, Messina, Italy.
Carmelo
C
Salpietro
Department of Pediatric Sciences, Genetics and Pediatric Immunology Unit, University of Messina, Messina, Italy.
Teresa
T
Arrigo
Mallory Bodies; Non-Alcoholic Fatty Liver Disease; Oxidative Stress