Therapeutic options in pediatric non alcoholic fatty liver disease: current status and future directions

Pietro Vajro,Claudio Pignata,Selvaggia Lenta,Mariacarolina Salerno,Giulia Paolella,Giancarlo Parenti,Roberta D’Aniello,Ida De Micco

doi:10.1186/1824-7288-38-55

Abstract

The epidemics of overweight and obesity has resulted in a significant increase of non alcoholic fatty liver disease (NAFLD), a potentially progressive condition. Currently, obesity related hepatopathy represents therefore the main cause of pediatric chronic liver disease. The first choice treatment at all ages is weight loss and/or lifestyle changes, however compliance is very poor and a pharmacological approach has become necessary. In the present article we present a systematic literature review focusing on established pediatric NALFD drugs (ursodeoxycholic acid, insulin sensitizers, and antioxidants) and on innovative therapeutic options as well.Regarding the former ones, a pediatric pilot study highlighted that ursodeoxycholic acid is not efficient on transaminases levels and bright liver. Similarly, a recent large scale, multicenter randomized clinical trial (TONIC study) showed that also insulin sensitizers and antioxidant vitamin E have scarce effects on serum transaminase levels. Among a large series of novel therapeutic approaches acting on recently proposed different pathomechanisms, probiotics seem hitherto the most interesting and reasonable option for their safety and tolerability. Toll-like receptors modifiers, Pentoxifylline, and Farnesoid X receptors agonists have been still poorly investigated, and will need further studies before becoming possible promising innovative therapeutic strategies.

Highlights

Non alcoholic fatty liver disease is nowadays the most common cause of chronic liver disease in pediatric age, as a result of the increasing prevalence of childhood obesity
The mainstay of non alcoholic fatty liver disease (NAFLD) therapy is represented by lifestyle interventions on obesogenic environment and sedentary life, which aim to improve obesity, obesity-related hepatic changes, and quality of life as well [2]
Lifestyle interventions Weight loss Weight reduction in NAFLD patients reduces the delivery of free fatty acids (FFA) to the liver, improving extrahepatic insulin sensitivity by means of a better peripheral glucose utilization

Summary

Introduction

Non alcoholic fatty liver disease is nowadays the most common cause of chronic liver disease in pediatric age, as a result of the increasing prevalence of childhood obesity. It represents a spectrum of liver diseases ranging from simple steatosis to steatohepatitis, with, in some cases, possible fibro/cirrhotic progression, increasing liver-related morbidity and mortality [1]. The mainstay of NAFLD therapy is represented by lifestyle interventions on obesogenic environment and sedentary life, which aim to improve obesity, obesity-related hepatic changes, and quality of life as well [2] This target is difficult to be achieved, and results are unsatisfactory. The aim of this article is to review current NAFLD treatments and possible novel options in the pediatric age group, by providing recent evidences from literature

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Results