Pediatric non-alcoholic fatty liver disease

Abstract

Non-alcoholic fatty liver disease (NAFLD) is the metabolic consequence of obesity and metabolic syndrome. The incidence of childhood NAFLD has significantly increased in relation to the increasing prevalence of childhood obesity and its metabolic sequelae: dyslipidemia, hypertension and type 2 diabetes mellitus. As the incidence of childhood NAFLD has increased, so too has the more severe histologic form of NAFLD known as non-alcoholic steatohepatitis (NASH). NASH, which is characterized by inflammation, ballooning degeneration, and fibrosis, may progress to chronic, irreversible liver disease or even cirrhosis during childhood. Based on current trends, NAFLD and consequently NASH are expected to become the most common causes of end-stage liver disease in both children and young adults, especially among male subjects. While the precise underlying pathophysiologic mechanism for development of NAFLD has not been identified, excessive fatty acid availability contributes to steatosis and the metabolic abnormalities associated with NAFLD. Indeed, increased adipocyte insulin resistance and lipolytic activity with marked elevation of circulating fatty acids are the likely pathogenic mechanisms leading to hepatic steatosis and, consequently, NAFLD. However, the factors influencing an individual's susceptibility for the development and progression of liver disease, such as NASH or cirrhosis, remain elusive. In addition, significant ethnic and gender differences association with the pediatric metabolic syndrome and NAFLD remain unexplained. Therefore, effective strategies are needed for identifying and treating NAFLD and preventing the progression to NASH and end stage liver disease. © 2012 by Nova Science Publishers, Inc. All rights reserved.