title: Nonalcoholic fatty liver disease and the heart in children and adolescents.
abstract: Over the last two decades, the rise in the prevalence rates of overweight and obesity explains the emergence of nonalcoholic fatty liver disease (NAFLD) as the leading cause of chronic liver disease worldwide. As described in adults, children and adolescents with fatty liver display insulin resistance, glucose intolerance, and dyslipidemia. Thus NAFLD has emerged as the hepatic component of the metabolic syndrome (MetS) and a strong cardiovascular risk factor even at a very early age. Several studies, including pediatric populations, have reported independent associations between NAFLD and markers of subclinical atherosclerosis including impaired flow-mediated vasodilation, increased carotid artery intima-media thickness, and arterial stiffness, after adjusting for cardiovascular risk factors and MetS. Also, it has been shown that NAFLD is associated with cardiac alterations, including abnormal left ventricular structure and impaired diastolic function. The duration of these subclinical abnormalities may be important, because treatment to reverse the process is most likely to be effective earlier in the disease. In the present review, we examine the current evidence on the association between NAFLD and atherosclerosis as well as between NAFLD and cardiac dysfunction in the pediatric population, and discuss briefly the possible biological mechanisms linking NAFLD and cardiovascular changes. We also address the approach to treatment for this increasingly prevalent disease, which is likely to have an important future global impact on the burden of ill health, to prevent not only end-stage liver disease but also cardiovascular disease.
authors.affiliation: Lucia Pacifico, Caterina Anania, Antonio De Merulis, Sara Romaggioli, Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Pacifico
authors.affiliation: Lucia Pacifico, Caterina Anania, Antonio De Merulis, Sara Romaggioli, Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Chiesa
authors.affiliation: Lucia Pacifico, Caterina Anania, Antonio De Merulis, Sara Romaggioli, Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Anania
authors.affiliation: Lucia Pacifico, Caterina Anania, Antonio De Merulis, Sara Romaggioli, Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: De Merulis
authors.affiliation: Lucia Pacifico, Caterina Anania, Antonio De Merulis, Sara Romaggioli, Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy.
authors.forename: John Frederick
authors.initials: JF
authors.lastname: Osborn
authors.affiliation: Lucia Pacifico, Caterina Anania, Antonio De Merulis, Sara Romaggioli, Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Romaggioli
authors.affiliation: Lucia Pacifico, Caterina Anania, Antonio De Merulis, Sara Romaggioli, Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Gaudio
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control; D002648:Child; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism / Q000628:therapy; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D040242:Risk Reduction Behavior
keywords: Atherosclerosis; Cardiac function; Cardiac structure; Children; Nonalcoholic fatty liver disease
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