Departments of Pathology Medicine, Teikyo University School of Medicine, Tokyo Division of Hepatology and Gastroenterology, Children's Center for Health and Development, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan.
Hepatology Research (Impact Factor: 2.74). 11/2011; 41(11):1066-74. DOI: 10.1111/j.1872-034X.2011.00855.x
Aim: Non-alcoholic steatohepatitis (NASH) has been classified pathologically into type 1 (characterized by ballooning and perisinusoidal fibrosis) and type 2 (characterized by portal inflammation and portal fibrosis). Reportedly, type 2 NASH has been the most commonly observed histopathological feature in pediatric non-alcoholic fatty liver disease (NAFLD). While only a few studies have documented the histopathology of pediatric NAFLD so far, appropriate histopathological classification or characteristics of pediatric NAFLD, and the disease incidence correlation with race or ethnicity are still controversial.
Methods: In this study, we compared the clinical and histopathological characteristics of NAFLD in 34 pediatric and 23 adult cases.
Results: We found that pediatric steatosis was more severe than adult steatosis. Perisinusoidal fibrosis was significantly milder in pediatric cases than in adult cases. Lobular inflammation and ballooning was found to be milder in pediatric cases than in adult cases. On the other hand, portal inflammation was more severe in pediatric cases than in adult cases. The so-called borderline zone 1 NASH, similar to type 2 NASH, was observed in 21% of pediatric subjects; this rate was more than twice that in adult subjects. Fifty percent of pediatric cases showed overlapping features of types 1 and 2 NASH. Intralobular and portal changes showed positive and significant correlations with each other. Serum aminotransferase levels reflected the histopathological severity of NAFLD.
Conclusion: We confirmed that pediatric NAFLD exhibits histopathological features that are different from adult NAFLD. The classification consisting of “type 1 NASH” and “type 2 NASH” may be impractical.
"Type 1 is similar to the adult pattern, characterized by zone 3 accentuation of steatosis, ballooning degeneration, and/or perisinusoidal fibrosis; type 2, more frequent in children, is characterized by zone 1 accentuation of steatosis or panacinar steatosis, portal inflammation, and/or fibrosis in the absence of ballooning and perisinusoidal fibrosis . Thereafter, an overlap pattern, with a variable combination of the features of type 1 and type 2, has been demonstrated in Ͼ50% of pediatric NAFLD cases  ; therefore, this classification has not been widely used in research studies or in clinical practice . In an attempt to standardize the histological criteria for the diagnosis of fatty liver, a variety of histological scoring systems were developed. "
[Show abstract][Hide abstract] ABSTRACT: Nonalcoholic fatty liver disease is rapidly becoming one of the most common liver diseases in the pediatric population in industrialized countries because of the growing prevalence of obesity and overweight. For this reason, there is a keen and broad interest among researchers to identify new diagnostic noninvasive tools and novel treatment modalities for this condition. Unfortunately, to date, liver biopsy remains the imperfect gold standard for diagnosis. In addition, available noninvasive markers are not fully satisfactory for the diagnosis of fatty liver. Although in recent years many pharmacological agents, on the basis of pathogenetic mechanism of the disease, have been attempted, to date, the guidelines for the management of fatty liver are still lacking. Establishing effective therapeutic strategies to treat the disease represents the challenge for pediatric hepatologists in the near future. In this article, we briefly review the current knowledge and ideas concerning pediatric nonalcoholic fatty liver disease, and discuss the new perspective therapies.
Journal of Adolescent Health 10/2012; 51(4):305–312. DOI:10.1016/j.jadohealth.2012.01.010 · 3.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nonalcoholic fatty liver disease (NAFLD) is a condition in which excess fat accumulates in the liver of a patient without a history of alcohol abuse. Nonalcoholic steatohepatitis (NASH), a severe form of NAFLD, can progress to liver cirrhosis and hepatocellular carcinoma. NAFLD is regarded as a hepatic manifestation of metabolic syndrome and incidence has been increasing worldwide in line with the increased prevalence of obesity, type 2 diabetes, and hyperlipemia. Animal models of NAFLD/NASH give crucial information, not only in elucidating pathogenesis of NAFLD/NASH but also in examining therapeutic effects of various agents. An ideal model of NAFLD/NASH should correctly reflect both hepatic histopathology and pathophysiology of human NAFLD/NASH. Animal models of NAFLD/NASH are divided into genetic, dietary, and combination models. In this paper, we review commonly used animal models of NAFLD/NASH referring to their advantages and disadvantages.
World Journal of Gastroenterology 05/2012; 18(19):2300-8. DOI:10.3748/wjg.v18.i19.2300 · 2.37 Impact Factor
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