Pediatric NAFLD: an overview and recent developments in diagnostics and treatment

ABSTRACT

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children and adults in industrialized countries. Besides liver-related morbidity, NAFLD is also associated with an increased risk of cardiovascular disease, type 2 diabetes and mortality at adult age. However, despite the high prevalence and serious complications, diagnosing and staging of disease remains complicated due to a lack of accurate screening tools and non-invasive methods to detect fibrosis.

Areas covered: Recent insights in epidemiology, pathogenesis, diagnostic evaluation and treatment options in pediatric NAFLD are being reviewed, with a particular focus on new developments in diagnostic tools.

Expert opinion: Due to their long life span, children with NAFLD are particularly at risk of complications in their lifetime. Therefore, an effective screening strategy for children to identify those with NAFLD at risk of complications is urgently needed. This is further underscored by new pharmacological therapies that are expected to become available in the next 5 years. Momentarily no accurate non-invasive method for diagnosing pediatric NAFLD is available. New promising biomarkers and imaging tools could hopefully provide better screening tools and could contribute to the development of a successful management plan to identify children with NAFLD.

KEYWORDS:

• Biomarkers
• children
• epidemiology
• imaging
• non-alcoholic fatty liver disease
• obesity
• pathogenesis

Article highlights

• Due to the rise in obesity, non-alcoholic fatty liver disease (NAFLD) has become a major public health problem in adults and children in industrialized countries.

• NAFLD, and in particular NASH and fibrosis, is not only associated with liver-related morbidity, but also with an increased risk of cardiovascular disease, type 2 diabetes and mortality at adult age.

• Pediatric NAFLD is of particular concern, as children given their longer life span, could be at increased risk of complications in their lifetime.

• Diagnosing and staging NAFLD in clinical practice remains complex as no accurate screening tool exists.

• New non-invasive diagnostic tools for detecting liver steatosis and fibrosis have been developed and show promising results but lack validation in the pediatric population. Non-invasive markers for inflammation for use in clinical practice are still lacking.

• Despite its limited effectiveness, lifestyle intervention remains the mainstay treatment for NAFLD in children as no drug therapy is registered. Ongoing phase 3 trials on pharmacological therapies in adults have shown efficacy and pediatric trials are due to follow.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Additional information

Funding

This paper was not funded.