Pediatric non-alcoholic fatty liver disease: Recent solutions, unresolved issues, and future research directions

作     者：Maria Grazia Clemente Claudia Mandato Marco Poeta Pietro Vajro 

作者机构：Pediatric ClinicDepartment of SurgicalMicrosurgical and Medical SciencesUniversity of Sassari07100 SassariItaly Pediatrics of AORN Santobono-Pausilipon80123 NaplesItaly PediatricsDepartment of MedicineSurgery and Dentistry'Scuola Medica Salernitana'University of Salerno84081 BaronissiItaly ELFID European Laboratory for the Investigation of Food Induced Disease80138 NaplesItaly 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2016年第22卷第36期

页      面：8078-8093页

核心收录：

学科分类：1002[医学-临床医学] 100202[医学-儿科学] 10[医学] 

主　　题：Non-alcoholic fatty liver disease Childhood obesity Non-alcoholic steatohepatitis Hepatic metabolic syndrome Non-alcoholic fatty liver disease diagnosis 

摘      要：Non-alcoholic fatty liver disease(NAFLD) in children is becoming a major health concern. A multiple-hit pathogenetic model has been suggested to explain the progressive liver damage that occurs among children with NAFLD. In addition to the accumulation of fat in the liver, insulin resistance(IR) and oxidative stress due to genetic/epigenetic background, unfavorable lifestyles, gut microbiota and gut-liver axis dysfunction, and perturbations of trace element homeostasis have been shown to be critical for disease progression and the development of more severe inflammatory and fibrotic stages [non-alcoholic steatohepatitis(NASH)]. Simple clinical and laboratory parameters, such as age, history, anthropometrical data(BMI and waist circumference percentiles), blood pressure, surrogate clinical markers of IR(acanthosis nigricans), abdominal ultrasounds, and serum transaminases, lipids and glucose/insulin profiles, allow a clinician to identify children with obesity and obesity-related conditions, including NAFLD and cardiovascular and metabolic risks. A liver biopsy(the imperfect gold standard) is required for a definitive NAFLD/NASH diagnosis, particularly to exclude other treatable conditions or when advanced liver disease is expected on clinical and laboratory grounds and preferably prior to any controlled trial of pharmacological/surgical treatments. However, a biopsy clearly cannot represent a screening procedure. Advancements in diagnostic serum and imaging tools, especially for the non-invasive differentiation between NAFLD and NASH, have shown promising results, e.g., magnetic resonance elastography. Weight loss and physical activity should be the first option of *** pharmacological treatments are still under development; however, drugs targeting IR, oxidative stress, proinflammatory pathways, dyslipidemia, gut microbiota and gut liver axis dysfunction are an option for patients who are unable to comply with the recommended lifestyle changes