Nonalcoholic Fatty Liver Disease in Children

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the pediatric population, present in 3–12 % of children from industrialized nations. In children, NAFLD is more common in boys than girls. The prevalence of NAFLD increases with age and with obesity. The pathogenesis is influenced by maternal factors such as preconception weight and gestational diabetes. Guidelines exist that recommend screening obese children for NAFLD; however, there is controversy in the implementation of these guidelines. In children, the available evidence does not support the use of ultrasound for diagnosis or grading of fatty liver. MRI is promising, but at this time does not have sufficient accuracy to be considered diagnostic for an individual child. Diagnosis of NAFLD in children ultimately requires liver biopsy. The histology of NAFLD in children differs from that of adults and is characterized by more severe steatosis, greater portal inflammation and fibrosis, and less hepatocyte ballooning and perisinusoidal fibrosis. Advanced fibrosis has been reported in 5–15 % of children with NAFLD. Cardiovascular outcomes are also important as children with NAFLD have high rates of dyslipidemia, hypertension, and left ventricular structural and functional abnormalities. Adolescence is a vulnerable developmental period, and anxiety, depression, and impaired quality of life are all common in pediatric NAFLD. Clinical management is focused on the assessment of and improvement in global health with an emphasis on lifestyle optimization. Because of the prevalence and severity of NAFLD in children, targeted therapies are a pressing need.