Treatment of Non-Alcoholic Fatty Liver Disease (NAFLD) in the Paediatric Population

Ebe      D'Adamo; Francesco      Chiarelli; Angelika      Mohn

Abstract

The prevalence of childhood obesity as well as of the obesity-related complications is rapidly increasing worldwide in the paediatric age. Insulin resistance (IR) is a common feature of childhood obesity and a key component of its metabolic and cardiovascular complications which are already present in this age group. NAFLD is the most common cause of hepatic steatosis disease in obese children and adolescents and is a spectrum of liver diseases ranging from simple fatty infiltration of the liver (hepatic steatosis) to steato-hepatitis and fibrosis. The pathophysiology of NAFLD has been described on the basis of a “two-hit model”. The “first hit” is characterized by the effect of IR and subsequent increase of fatty acids in the hepatocytes. The “second hit” is due to the contribution of increased oxidative stress, which promotes hepatic inflammation and fibrosis. On the basis of the continuous progresses in understanding the pathogenesis of NALD, new potentially applicable therapeutic strategies are being developed. Although, at the moment the standard treatment is based on the lifestyle changes, including diet and increased physical activity, several authors postulated the adoption of drugs, which can improve IR and oxidative stress. Pharmacotherapy includes lipid lowering agents, ursodeoxycholic acid, antioxidants and molecules able to improve insulin sensitivity. However, in literature no consensus on the treatment of NAFLD is available, especially in children and adolescents. The aim of this review is to summarize recent patent and what is known about paediatric NAFLD in terms of treatment.

Keywords: Non-alcoholic fatty liver disease, lifestyle intervention, children, antioxidant therapy, ursodeoxycholic acid (UDCA), insulin sensitizers, orlistat, sibutramin