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  • Review Article
  • Published:

Caring for children with NAFLD and navigating their care into adulthood

Nature Reviews Gastroenterology & Hepatology volume 12, pages 617–628 (2015)Cite this article

Subjects

Key Points

  • Coincident with the rise of obesity, NAFLD has become the most common cause of chronic liver injury in the industrialized world in both children and adults

  • The mainstay of treatment for both adult and paediatric NASH are diet and exercise resulting in weight loss

  • Medical treatment of NAFLD should be considered only for those patients with biopsy-proven NASH who have failed lifestyle intervention; current medical therapies lack long-term safety and efficacy data

  • Transitioning to adult care should begin in early adolescence and should be multifaceted

  • Paediatric providers should prepare patients to take an active role in their care, have an understanding of their disease, and should assess logistical and psychosocial challenges that might impair transition

  • Adult providers should be aware of the differences between paediatric and adult NAFLD to provide a smooth transition process that is integrated with the paediatric model

Abstract

NAFLD is the most common chronic liver disease in children and adults, with its prevalence closely associated with obesity and other features of the metabolic syndrome. As young adults with NAFLD transition from the paediatric care environment to adult services, establishing a coordinated model of transition to ensure ongoing and appropriate care is critical. Enabling a smooth transfer begins with an understanding of the key differences between paediatric and adult NAFLD as well as the psychosocial factors that affect older adolescents. This Review summarizes the literature on paediatric NAFLD from the past two decades with a focus on the differences in epidemiology, pathology, pathophysiology and treatment that are relevant to clinicians who transition paediatric patients to adult care. An integrated model, which employs a team of adult and paediatric providers who can address the psychosocial, cognitive and logistical challenges of transition, provides the best opportunity for a seamless and coordinated transfer to adult care.

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Figure 1: Histologic features of NASH.
Figure 2: Characteristics associated with NAFLD in adult and paediatric patients.
Figure 3: Algorithm for the diagnosis and management of paediatric NAFLD.

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Acknowledgements

The authors would like to thank M. Salamao for providing the images of NAFLD used in this paper. A.A.M., R.L. and J.E.L. are supported by NIH U01DK61734.

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Authors and Affiliations

  1. Division of Paediatric Gastroenterology, Hepatology and Nutrition, Columbia University Medical Centre, 622 West 168th Street, New York, 10032, NY, USA

    Ali A. Mencin & Joel E. Lavine

  2. Division of Gastroenterology, University of California at San Diego, 9500 Gilman Drive, La Jolla, 92093, CA, USA

    Rohit Loomba

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  1. Ali A. Mencin
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A.A.M. researched data for the article. All the authors substantially contributed to discussion of content, wrote the article, and reviewed/edited the manuscript before submission.

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Correspondence to Joel E. Lavine.

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Mencin, A., Loomba, R. & Lavine, J. Caring for children with NAFLD and navigating their care into adulthood. Nat Rev Gastroenterol Hepatol 12, 617–628 (2015). https://doi.org/10.1038/nrgastro.2015.146

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