Serum hyaluronic acid for the screening of progressive nonalcoholic steatohepatitis in children: a promising approach.

Nonalcoholic fatty liver disease (NAFLD) represents now the leading cause of liver disease in children in Western countries. NAFLD encompasses a wide spectrum of liver pathology ranging from simple uncomplicated steatosis to steatohepatitis (NASH), with possible progression to cirrhosis and hepatocarcinoma. Presently only liver biopsy can discriminate patients with NASH, but it remains a costly and invasive procedure, and in children is still perceived to carry a higher risk of complications, and is less accepted than in adults. Thus, there is an urgent need of noninvasive markers of NASH. In the present issue, Nobili and coworkers demonstrate that the evaluation of serum hyaluronic acid (HA), a relatively cheap, immediate, and readily available approach, predicts liver fibrosis independently of biochemical indices of liver damage in 100 children with NAFLD referred to a tertiary care center, and may allow to identify by a double cut-off approach those without fibrosis and those with moderate-severe fibrosis with a high specificity, without recurring to not yet available complex tests for the prediction of fibrosis requiring the evaluation of predictive algorithms. These findings represent a significant step forward and should be replicated in independent series followed at tertiary centers and, thanks to the relatively low cost of the method, in populations at lower risk of liver damage.