Paediatric non alcoholic fatty liver disease: An emerging threat

Abstract

The aim of this study was to review current knowledge about nonalcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) and increase awareness among general paediatricians and family doctors. NAFLD and NASH represent the commonest causes of chronic liver disease in children at the present time. Increasing prevalence is thought to result from a combination of several environmental factors including high calorie intake, a carbohydrate-rich diet and a sedentary lifestyle. Frequent familial clustering indicates that some genetic factors, such as insulin resistance and different ethnic prevalence, could also have a role in pathogenesis. It is likely that NAFLD represents the initial step in pathogenesis step, whereas NASH is a more advanced, severe phase of the same process. Histopathologically, the main difference between the two is presence of an inflammatory component in NASH which may be lobular, portal or both, in addition to varying degrees of fibrosis. Due to relatively slowly progressive nature, this potentially preventable disease is likely to become the leading indication for liver transplantation in adulthood. The commonest phenotype is associated with truncal (central) obesity, which is also a wellrecognised risk factor for chronic metabolic, cardiovascular, musculoskeletal and mental health disorders. Therefore, controlling excessive weight is an important public health measure, but due to its complex pathogenic background its implementation remains difficult. Regular physical exercise should be encouraged. Insulin sensitising agents, anti-oxidants, polyunsaturated fatty acids and probiotics have all been trialled as potential therapeutic agents but a favourable response is not universal.

Conclusion. NAFLD is a common but difficult-totreat cause of chronic liver disease. The management is complex and includes combination of promoting active lifestyle, calorie-restricted diet and weight loss. Medical treatment has a limited role.