title: Controversy in the diagnosis of pediatric non-alcoholic fatty liver disease.
abstract: In the last years childhood obesity has reached epidemic diffusion with about 200 million school-age children worldwide being overweight or obese. Simultaneously, also the prevalence of obesity comorbidities has been increased and the non-alcoholic fatty liver disease (NAFLD) has become the most common form of liver disease in childhood. Also if there are some not-invasive diagnostic possibilities, the diagnostic gold standard is represented by hepatic biopsy giving to the clinicians the possibility to both diagnose the NAFLD and evaluate its progression to fibrosis or cirrhosis with greater certainty than other techniques. The use of liver biopsy in clinical practice causes debate among health care providers. Most patients with NAFLD have a good prognosis and, therefore, the risks of a liver biopsy seem to outweigh the clinical benefits. It represents an impractical screening procedure because it is both expensive and invasive and, moreover, sampling error of liver biopsy can result in substantial misdiagnosis and staging inaccuracies because histological lesions of non-alcoholic steatohepatitis are unevenly distributed throughout the liver parenchyma. The liver biopsy limitations have led the clinicians to use, also if highly imperfect, non-invasive methods to diagnose and stage NAFLD. In this editorial the main diagnostic controversies in pediatric NAFLD are examined.
authors.affiliation: Pierluigi Marzuillo, Anna Grandone, Laura Perrone, Emanuele Miraglia del Giudice, Department of women and children and general and specialized surgery, Seconda Università degli Studi di Napoli, 80138 Naples, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Marzuillo
authors.affiliation: Pierluigi Marzuillo, Anna Grandone, Laura Perrone, Emanuele Miraglia del Giudice, Department of women and children and general and specialized surgery, Seconda Università degli Studi di Napoli, 80138 Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Grandone
authors.affiliation: Pierluigi Marzuillo, Anna Grandone, Laura Perrone, Emanuele Miraglia del Giudice, Department of women and children and general and specialized surgery, Seconda Università degli Studi di Napoli, 80138 Naples, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Perrone
authors.affiliation: Pierluigi Marzuillo, Anna Grandone, Laura Perrone, Emanuele Miraglia del Giudice, Department of women and children and general and specialized surgery, Seconda Università degli Studi di Napoli, 80138 Naples, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Miraglia Del Giudice
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001706:Biopsy; D002648:Child; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D008099:Liver / Q000473:pathology*; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis* / Q000453:epidemiology; D063766:Pediatric Obesity / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors
keywords: Alanine transaminase; Biopsy; Liver; Non-alcoholic fatty liver disease; Pediatric; Ultrasound