title: Nonalcoholic steatohepatitis and insulin resistance in children.
abstract: Various pathological conditions can cause fatty liver in children. Nonalcoholic steatohepatitis (NASH) in children has been known since 1983. However, NASH diagnosed in childhood does not have a favorable outcome. The pathological characteristics of NASH are significantly different between children and adults. Nonalcoholic fatty liver disease (NAFLD)/NASH is accompanied by insulin resistance, which plays a pivotal role in its pathophysiology in both children and adults. In NASH, a "two-hit" model involving triglyceride accumulation (first hit) and liver damage (second hit) has been accepted. Insulin resistance was found to correlate with changes in fat levels; however, it did not correlate with fibrosis or NAFLD activity score in children. Therefore, insulin resistance may be important in the first hit. Because there is obvious familial clustering in NASH, genetic predisposition as well as environmental factors including diet might be the second hit of NAFLD/NASH.
authors.affiliation: Mikage Arata, Junya Nakajima, Shigeo Nishimata, Tomomi Nagata, Hisashi Kawashima, Department of Pediatrics, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Mikage
authors.initials: M
authors.lastname: Arata
authors.affiliation: Mikage Arata, Junya Nakajima, Shigeo Nishimata, Tomomi Nagata, Hisashi Kawashima, Department of Pediatrics, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Nakajima
authors.affiliation: Mikage Arata, Junya Nakajima, Shigeo Nishimata, Tomomi Nagata, Hisashi Kawashima, Department of Pediatrics, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Nishimata
authors.affiliation: Mikage Arata, Junya Nakajima, Shigeo Nishimata, Tomomi Nagata, Hisashi Kawashima, Department of Pediatrics, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Nagata
authors.affiliation: Mikage Arata, Junya Nakajima, Shigeo Nishimata, Tomomi Nagata, Hisashi Kawashima, Department of Pediatrics, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kawashima
keywords: Homeostasis model assessment as an index of insulin resistance; Insulin resistance; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; Obesity