Abstract
Non-Alcoholic Fatty Liver Disease (NAFLD) is now the most prevalent form of chronic liver disease, affecting 10%–20% of the general paediatric population. Within the next 10 years it is expected to become the leading cause of liver pathology, liver failure and indication for liver transplantation in childhood and adolescence in the Western world. While our understanding of the pathophysiological mechanisms underlying this disease remains limited, it is thought to be the hepatic manifestation of more widespread metabolic dysfunction and is strongly associated with a number of metabolic risk factors, including insulin resistance, dyslipidaemia, cardiovascular disease and, most significantly, obesity. Despite this, ”paediatric” NAFLD remains under-studied, under-recognised and, potentially, undermanaged. This article will explore and evaluate our current understanding of NAFLD in childhood and adolescence and how it differs from adult NAFLD, in terms of its epidemiology, pathophysiology, natural history, diagnosis and clinical management. Given the current absence of definitive radiological and histopathological diagnostic tests, maintenance of a high clinical suspicion by all members of the multidisciplinary team in primary and specialist care settings remains the most potent of diagnostic tools, enabling early diagnosis and appropriate therapeutic intervention.
Highlights
Non-Alcoholic Fatty Liver Disease (NAFLD) encompasses a spectrum of chronic liver disease, characterised by excessive hepatic fat accumulation in the absence of significant alcohol consumption, occurring with or without hepatic inflammation and fibrosis [1]
In adults, NAFLD has been associated with myocardial insulin resistance, altered cardiac energy metabolism, abnormal left ventricular structure and impaired diastolic function; the duration and severity of these abnormalities in cardiac function likely contributing to the increased risk of heart failure and cardiovascular mortality in obese patients and, those with NAFLD [50]
The severity of Insulin Resistance (IR) is strongly associated with the amount of hepatic fat accumulation, independently of global and intra-abdominal adiposity and the prevalence of NAFLD is greater in patients with hyperglycaemia and type II diabetes, with evidence of NAFLD present on ultrasound in up to 70% of clinical cases [14,32]
Summary
Non-Alcoholic Fatty Liver Disease (NAFLD) encompasses a spectrum of chronic liver disease, characterised by excessive hepatic fat accumulation (steatosis) in the absence of significant alcohol consumption, occurring with or without hepatic inflammation and fibrosis [1]. That normal-weight individuals with NAFLD appear to present at a younger age than those who are overweight or obese and demonstrate a decreased association with components of the metabolic syndrome, such as hypertension and insulin resistance [30,31]. This has given rise to the controversial hypothesis that paediatric NAFLD might, represent a group of related but pathophysiologically distinct clinical phenomenologies
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