Diagnosis of Nonalcoholic Fatty Liver Disease in Children and Adolescents: Position Paper of the ESPGHAN Hepatology Committee

Department of Pediatrics, Medical School, University of Salerno, Salerno, Italy.
Journal of pediatric gastroenterology and nutrition (Impact Factor: 2.63). 03/2012; 54(5):700-13. DOI: 10.1097/MPG.0b013e318252a13f
Source: PubMed


Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children and adolescents in the United States, and most probably also in the rest of the industrialized world.As the prevalence of NAFLD in childhood increases with the worldwide obesity epidemic, there is an urgent need for diagnostic standards that can be commonly used by pediatricians and hepatologists. To this end, we performed a PubMed search of the adult and pediatric literature on NAFLD diagnosis through May 2011 using Topics and/or relevant Authors as search words. According to the present literature, NAFLD is suspected based on the association of fatty liver combined with risk factors (mainly obesity), after the exclusion of other causes of liver disease. The reference but imperfect standard for confirming NAFLD is liver histology. The following surrogate markers are presently used to estimate degree of steatosis and liver fibrosis and risk of progression to end-stage liver disease: imaging by ultrasonography or magnetic resonance imaging, liver function tests, and serum markers of liver fibrosis.NAFLD should be suspected in all of the overweight or obese children and adolescents older than 3 years with increased waist circumference especially if there is a NAFLD history in relatives. The typical presentation, however, is in children ages 10 years and older. The first diagnostic step in these children should be abdominal ultrasound and liver function tests, followed by exclusion of other liver diseases. Overweight/obese children with normal ultrasonographic imaging and normal liver function tests should still be monitored due to the poor sensitivity of these tests at a single assessment.Indications for liver biopsy include the following: to rule out other treatable diseases, in cases of clinically suspected advanced liver disease, before pharmacological/surgical treatment, and as part of a structured intervention protocol or clinical research trial.

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    • "Alagille syndrome, progressive familial intrahepatic cholestasis, and cystic fibrosis should also be sought. Non-alcoholic fatty liver disease (NAFLD) is usually suspected in case of fatty liver on ultrasound examination in an obese child [9] [10]. An elevated AST/ALT ratio may be indicative of non-alcoholic steatohepatitis (NASH), a progressive and more serious condition [11]. "
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    ABSTRACT: The presence of elevated aminotransferases on routine blood tests can reveal liver diseases of various severities. In children, etiologies are more numerous and complex than those usually considered in adults. Information derived from family and personal history, physical examination and basic laboratory data are necessary to reach a timely and correct diagnosis. A stepwise approach is proposed to guide the timing of more specific investigations that are often required. (C) 2014 Published by Elsevier Masson SAS.
    Gastroentérologie Clinique et Biologique 04/2014; 38(3). DOI:10.1016/j.clinre.2014.02.010 · 1.64 Impact Factor
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    • "Hepatology and Nutrition (ESPGHAN) has published their guidelines for diagnosis of NAFLD [11] "
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    ABSTRACT: Central obesity represents the major factor responsible for NAFLD, but several immunological and endocrinological mechanisms are involved in fatty infiltration in the liver, inflammation and fibrosis. Gut microbiota and genetic factors were recently indicated as major players in liver injury. Loss of weight and physical activity represent till now the cornerstone of treatment, but they are very difficult to obtain and to maintain. Several pharamocotherapeutic approaches including insulin sensitizers, omega-3 fatty acids and vitamin E have been extensively studied in randomized trials, but final conclusions still could not be formulated. Therefore, new treatments based on pathogenetic mechanisms leading to NAFLD are under evaluation to establish the effective pharmacological therapy of this disorder.
    Gastroentérologie Clinique et Biologique 04/2014; 38(4). DOI:10.1016/j.clinre.2014.02.008 · 1.64 Impact Factor
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    • "Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease, both in adults and paediatric patients, where it requires a detailed work-up, including a vast list of many rare metabolic or systemic diseases presenting with fatty liver (so-called " NASH trash bin " ) [45] [46]. Due to its propensity for progression to fibrotic non-alcoholic steatohepatitis (NASH) and occasionally to cirrhosis at all ages, diagnosis and proper treatment are key issues. "
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    ABSTRACT: Advances in the management of children with chronic liver disease have enabled many to survive into adulthood with or without their native livers, so that the most common of these conditions are becoming increasingly common in adult hepatology practice. Because the aetiologies of chronic liver disease in children may vary significantly from those in adulthood, adults with paediatric-onset chronic liver disease may often present with clinical manifestations unfamiliar to their adulthood physician. Transition of medical care to adult practice requires that the adulthood medical staff (primary physicians and subspecialists) have a comprehensive knowledge of childhood liver disease and their implications, and of the differences in caring for these patients. Pending still unavailable Scientific Society guidelines, this article examines causes, presentation modes, evaluation, management, and complications of the main paediatric-onset chronic liver diseases, and discusses key issues to aid in planning a program of transition from paediatric to adult patients.
    Digestive and Liver Disease 12/2013; 46(4). DOI:10.1016/j.dld.2013.10.018 · 2.96 Impact Factor
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