Dieter Furthner1,2, Daniel Weghuber2,3, Christopher Dalus2,3, Andreas Lukas1,2, Hannah N Stundner-Ladenhauf4, Harald Mangge5, Thomas Pixner1,2. 1. Department of Pediatric and Adolescent Medicine, Salzkammergutklinikum Voecklabruck, Voecklabruck, Austria. 2. Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria. 3. University Children's Hospital, Paracelsus Medical University, Salzburg, Austria. 4. University Hospital of Pediatric and Adolescent Surgery, Paracelsus Medical University, Salzburg, Austria. 5. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
Abstract
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the leading hepatic disease in children, ranging from steatosis to steatohepatitis and fibrosis. Age, sex, hormonal levels, pubertal stages, genetic risk- and epigenetic factors are among the many influencing factors. Appearing predominantly in children with obesity, but not exclusively, it is the liver's manifestation of the metabolic syndrome but can also exist as an isolated entity. SUMMARY: Pediatric NAFLD differs from the adult phenotype. This narrative review on NAFLD in children with obesity provides an overview of the current knowledge on risk factors, screening, and diagnostic methods, as well state-of-the-art treatment. The recent discussion on the proposition of a new nomenclature - Metabolic [Dysfunction-] Associated Liver Disease - is featured, and current gaps of knowledge are discussed. KEY MESSAGES: Currently, there is no international consensus on screening and monitoring of pediatric NAFLD. With lifestyle interventions being the cornerstone of treatment, no registered pharmacological treatment for pediatric NAFLD is available. Development and validation of additional noninvasive biomarkers, scores and imaging tools suitable to subcategorize, screen and monitor pediatric patients are necessary. With a variety of upcoming and promising agents, clear recommendations for pediatric nonalcoholic steatohepatitis trials are urgently needed.
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the leading hepatic disease in children, ranging from steatosis to steatohepatitis and fibrosis. Age, sex, hormonal levels, pubertal stages, genetic risk- and epigenetic factors are among the many influencing factors. Appearing predominantly in children with obesity, but not exclusively, it is the liver's manifestation of the metabolic syndrome but can also exist as an isolated entity. SUMMARY: Pediatric NAFLD differs from the adult phenotype. This narrative review on NAFLD in children with obesity provides an overview of the current knowledge on risk factors, screening, and diagnostic methods, as well state-of-the-art treatment. The recent discussion on the proposition of a new nomenclature - Metabolic [Dysfunction-] Associated Liver Disease - is featured, and current gaps of knowledge are discussed. KEY MESSAGES: Currently, there is no international consensus on screening and monitoring of pediatric NAFLD. With lifestyle interventions being the cornerstone of treatment, no registered pharmacological treatment for pediatric NAFLD is available. Development and validation of additional noninvasive biomarkers, scores and imaging tools suitable to subcategorize, screen and monitor pediatric patients are necessary. With a variety of upcoming and promising agents, clear recommendations for pediatric nonalcoholic steatohepatitis trials are urgently needed.
Authors: Valérie Julian; Iris Ciba; Roger Olsson; Marie Dahlbom; Dieter Furthner; Julian Gomahr; Katharina Maruszczak; Katharina Morwald; Thomas Pixner; Anna Schneider; Bruno Pereira; Martine Duclos; Daniel Weghuber; David Thivel; Peter Bergsten; Anders Forslund Journal: Nutrients Date: 2021-12-24 Impact factor: 5.717
Authors: Thomas Pixner; Nathalie Stummer; Anna Maria Schneider; Andreas Lukas; Karin Gramlinger; Valérie Julian; David Thivel; Katharina Mörwald; Katharina Maruszczak; Harald Mangge; Julian Gomahr; Daniel Weghuber; Dieter Furthner Journal: Life (Basel) Date: 2022-06-05