Pediatric nonalcoholic fatty liver disease: a multidisciplinary approach

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Abstract

Nonalcoholic fatty liver disease (NAFLD) is a multifactorial condition, ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) with or without fibrosis. NAFLD affects both adults and children who present with particular risk factors, including obesity, sedentary lifestyle and/or a predisposing genetic background. The escalation of the prevalence of NAFLD in children worldwide is a worrying phenomenon because this disease is closely associated with the development of both cirrhosis and cardiometabolic syndrome in adulthood. The etiopathogenesis of primary NAFLD in children is unknown; however, considerable knowledge about the mechanisms of liver damage that occur during disease progression has been gathered over the past 30 years. Understanding the pathogenetic mechanisms, together with the histological pattern, provide the basis to characterize potential early predictors of the disease, suitable noninvasive diagnostic tools and design novel specific treatments and possible management strategies. Despite a few clinical trials on the use of antioxidants combined with lifestyle intervention for NAFLD that showed encouraging results, to date, no treatment guidelines exist for children with NAFLD. In this Review, we provide an overview of current concepts in epidemiology, histological features, etiopathogenesis, diagnosis and treatment of NAFLD in children and adolescents.

Key Points

  • Risk factors for pediatric NAFLD include obesity, insulin resistance, type 2 diabetes mellitus and the metabolic syndrome

  • In susceptible individuals, pediatric NAFLD can evolve to cirrhosis and eventually hepatocellular carcinoma

  • Knowledge of the pathology and pathogenesis of pediatric NAFLD drives current approaches in diagnosis and treatment

  • Noninvasive tools could be useful in the diagnosis of NAFLD in children, greatly reducing the need for liver biopsy

  • A multitarget and multidisciplinary approach is preferable, both in diagnosis of and therapy for pediatric NAFLD

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Figure 1: Schematic representation of the complex crosstalk between multiple factors and organs during NAFLD pathogenesis.
Figure 2: Liver histology of a child with NAFLD.
Figure 3: Management algorithm for children affected by primary NAFLD.

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Acknowledgements

We are grateful to Professor A. Ugazio, the current President of The Italian Society of Pediatrics, for his suggestions and editorial assistance.

Author information

A. Alisi, A. E. Feldstein, A. Villani and V. Nobili researched data for the article. All authors contributed equally to discussion of content and writing the article. A. Alisi, A. E. Feldstein, M. Raponi and V. Nobili reviewed and edited the manuscript before submission.

Correspondence to Valerio Nobili.

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