Abstract
Obesity-related non-alcoholic fatty liver disease (NAFLD) represents the most common cause of pediatric liver disease due to overweight/obesity large-scale epidemics. In clinical practice, diagnosis is usually based on clinical features, blood tests, and liver imaging. Here, we underline the need to make a correct differential diagnosis for a number of genetic, metabolic, gastrointestinal, nutritional, endocrine, muscular, and systemic disorders, and for iatrogenic/viral/autoimmune hepatitis as well. This is all the more important for patients who are not in the NAFLD classical age range and for those for whom a satisfactory response of liver test abnormalities to weight loss after dietary counseling and physical activity measures cannot be obtained or verified due to poor compliance. A correct diagnosis may be life-saving, as some of these conditions which appear similar to NAFLD have a specific therapy. In this study, the characteristics of the main conditions which require consideration are summarized, and a practical diagnostic algorithm is discussed.
Highlights
Obesity-related non-alcoholic fatty liver disease (NAFLD) has become one of the most common causes of pediatric liver disease, as a result of the parallel epidemics of overweight and childhood obesity [1]
The term NAFLD refers to a wide spectrum of histological hepatic lesions ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma as frequently seen in obese individuals
Beyond the neonatal age, when it is prevalently characterized by cholestasis, citrin deficiency may display as a diffusely fatty liver, which is histologically similar to NAFLD
Summary
Obesity-related non-alcoholic fatty liver disease (NAFLD) has become one of the most common causes of pediatric liver disease, as a result of the parallel epidemics of overweight and childhood obesity [1]. It is necessary to maintain a high index of suspicion and make an accurate differential diagnosis to rule out several other obesity-unrelated or coexistent liver diseases. This is all the more important for those patients who are not in the NAFLD classical age range and for those for whom a satisfactory response of liver test abnormalities to weight loss after dietary and physical activity counseling cannot be obtained or even verified due to poor compliance. The term NAFLD refers to a wide spectrum of histological hepatic lesions ranging from simple (usually macrovesicular) steatosis to non-alcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma as frequently seen in obese individuals (obesity-related liver disease). Early onset liver steatosis (for those
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