Nonalcoholic Fatty Liver Disease In Children: Recent Practice Guidelines, Where Do They Take Us?
Ashish Aggarwal, Kanika Puri, Suraj Thangada, Nizar Zein and Naim Alkhouri
Affiliation: Department of Pediatric Gastroenterology, A-111, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
Keywords: Nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, children, epidemiology, natural history, diagnosis,
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children and
adolescents in the United States. It is strongly associated with childhood obesity, insulin resistance and metabolic syndrome.
Although some children with NAFLD may remain asymptomatic, progression to nonalcoholic steatohepatitis
(NASH), and to advanced stages of fibrosis and cirrhosis is well recognized. Unfortunately, despite the increase in awareness
of this disease, there are still no reliable non-invasive diagnostic tests and liver biopsy remains the gold standard for
the diagnosis of NASH and staging of fibrosis. In addition, there are no approved pharmacological treatments currently.
Lifestyle modification remains the cornerstone of treatment. Team based multidisciplinary approach involving hepatologists,
endocrinologists, exercise physiologist, dieticians, and cardiologists may lead to better outcomes. Recently, the
American Association for the Study of Liver Diseases (AASLD) and European Society for Pediatric Gastroenterology,
Hepatology and Nutrition (ESPGHAN) committees have made recommendations for the diagnosis and management of
NAFLD in pediatric patients. This review focuses on current literature on epidemiology, natural history, pathogenesis
along with summarizing the recent guidelines on diagnosis and treatment of pediatric NAFLD.
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