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Non-alcoholic fatty liver disease and childhood obesity

  • Symposium: Gastroenterology & Hepatology
  • Published:
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Abstract

Obesity has emerged as a significant global health problem in the pediatric population. Pediatric liver disease is a serious complication of childhood obesity. Non-alcoholic steatohepatitis (NASH) is an entity in the spectrum of non-alcoholic fatty liver disease (NAFLD) ranges from fat in the liver — simple steatosis, NASH/ steatohepatitis — fat with in ammation and/or fibrosis to advanced fibrosis and cirrhosis when fat may no longer be present. NASH is associated with obesity, diabetes, insulin resistance (IR), and hypertriglyceridemia. Children get NAFLD, and the incidence of this pediatric liver disease is rising as childhood obesity becomes increasingly prevalent. Although much remains to be learned about pediatric NAFLD, it is already evident that children with NASH risk progressive liver damage, including cirrhosis. Liver biopsy is required for definitive diagnosis, and other causes of fatty liver in childhood must be excluded. Gradual weight loss through increased regular exercise and a low-fat, low-refined carbohydrate diet appears to be effective. Drug treatments are being developed. The important message is that childhood obesity poses important health problems, including but not limited to potentially severe chronic liver disease. Early diagnosis of children who are only overweight is a worthy goal so that strategies to limit obesity can be instituted as early as possible. Identification of genetic risks is important, but management will invariably require changes in environmental factors. In addition to individual treatment, a multifaceted, societal initiative is required for solving the childhood obesity epidemic.

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References

  1. Kaur S, Kapil U, Singh P. Pattern of chronic diseases amongst adolescent obese children in developing countries. Curr Sci 2005; 88(7): 1052–1056.

    Google Scholar 

  2. Moran JR, Ghishen FK, Halter SA, Greene HL. et al. Steatohepatitis in obese children: a cause of chronic liver dysfunction. Am J Gastroenterol 1983; 78(6): 374–377.

    PubMed  CAS  Google Scholar 

  3. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002; 346(16): 1221–1229.

    Article  PubMed  CAS  Google Scholar 

  4. Chan DF, Li AM, Chu WC, Chan MH, Wong EM, Liu EK et al. (2004). Hepatic steatosis in obese Chinese children. Int J Obes Relat Metab Disord 2004; 28: 1257–1263.

    Article  PubMed  CAS  Google Scholar 

  5. Bergomi AL, Iughetti N, Corciulo P et al. Italian multicenter study on liver damage in pediatric obesity. Int J Obes Relat Metab Disord 1998; 22(suppl 4): S22.

    Google Scholar 

  6. Guzzaloni G, Grugni G, Minocci A et al. Liver steatosis in juvenile obesity: correlations with lipid profile, hepatic biochemical parameters and glycemic and insulinemic responses to an oral glucose tolerance test. Int J Obes Relat Metab Disord 2000; 24(6): 772–776.

    Article  PubMed  CAS  Google Scholar 

  7. Engelmann G, Lenhartz H, Grulich-Henn J. Obesity and metabolic syndrome in children and adolescents. N Engl J Med 2004; 351(11): 1146.

    Article  PubMed  CAS  Google Scholar 

  8. Rashid M, Roberts EA. Non alcoholic steatohepatitis in children. J Pediatr Gastro Nutr 2000; 30(1): 48–53.

    Article  CAS  Google Scholar 

  9. Joseph AE, Saverymuttu SH, al-Sam S, Cook MG, Maxwell JD. Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease. Clin Radiol 1991; 43: 26–31.

    Article  PubMed  CAS  Google Scholar 

  10. Sanyal AJ. AGA Technical Review on Nonalcoholic Fatty Liver Disease. Gastroenterol 2002; 123: 1705–1725.

    Article  Google Scholar 

  11. Fishbein MH, Miner M, Mogren C, Chalekson J. The spectrum of fatty liver in obese children and the relationship of serum aminotransferases to severity of steatosis. J Pediatr Gastro Nutr 2003; 36(1): 54–61.

    Article  CAS  Google Scholar 

  12. Strauss RS, Barlow SE, Dietz WH. Prevalence of abnormal serum aminotransferases values in overweight and obese adolescents. J Pediatrics 2000; 136: 727–733.

    Article  CAS  Google Scholar 

  13. Manton ND, Lipsett J, Moore DJ, Davidson GP, Bourne AJ, Couper RTL. Non-alcoholic steatohepatitis in children and adolescents. Med J Aust 2000; 173: 476–479.

    PubMed  CAS  Google Scholar 

  14. Tazawa Y, Noguchi H, Nishinomiya F, Takada G. Effect of weight reduction on serum transaminases activities in children with simple obesity. J Pediatr 1996; 128(4): 587–588

    PubMed  CAS  Google Scholar 

  15. Franzese A, Vajro P, Argenziano et al. Liver involvement in obese children: Ultrasonography and liver enzyme levels at diagnosis and during follow up in an Italian population. Dig Dis Sci 1997; 42(7): 1428–1432.

    Article  PubMed  CAS  Google Scholar 

  16. Vajro P, Fontanella A, Perna C, Orso G, Tedescom, Vincenzo AD. Persistent hyperaminotransferasemia resolving after weight reduction in obese children. J Pediatr 1994; 125: 239–241.

    Article  PubMed  CAS  Google Scholar 

  17. Kawasaki T, Hashimoto N, Kikuchi T, Takahashi H, Uchiyama M. The relationship between fatty liver and hyperinsulinemia in obese children. J Pediatr Gastro Nutr 1997; 24: 317–321.

    Article  CAS  Google Scholar 

  18. Kinugasa A, Tsunamoto K, Furukawa N, Sawada T, Kusunoki T, Shimada N. Fatty liver and its fibrous changes found in simple obesity of children. J Pediatr Gatroenterol Nutrit 1984; 3: 408–414.

    Article  CAS  Google Scholar 

  19. Tominaga K, Kurata JH, Chen YK et al. Prevalence of fatty liver in Japanese children and relationship to obesity. Dig Dis Sci 1995; 40(9): 2002–2009.

    Article  PubMed  CAS  Google Scholar 

  20. Yamazaki K, Ichikawa M, Kazuma M, Shimizu H, Murata M. The risk of obesity in children (in Japanese). Pediatr Jpn 1987; 28: 619–623.

    Google Scholar 

  21. Murata M, Yamazaki K, Kanetugu K, Hoshina K. The hepatic injury of obesity in children (in Japanese). Jpn Med J 1976; 2724: 28–32.

    Google Scholar 

  22. Baldridge AD, Atayde ARP, Cook FG, Higgins L, Lavine JE. Idiopathic steatohepatitis in childhood: A multi-centric retrospective study. J Pediatrics 1995; 127(5): 700–704.

    Article  CAS  Google Scholar 

  23. Saadeh S, Younossi ZM, Remer EM et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 2002; 123: 745–750.

    Article  PubMed  Google Scholar 

  24. Hultcrantz R, Gabrielsson N. Patients with persistent elevation of aminotransferases: investigation with ultrasonography, radionuclide imaging and liver biopsy. J Intern Med 1993; 233: 7–12.

    Article  PubMed  CAS  Google Scholar 

  25. Sanford NL, Walsh P, Matis C, Baddeley H, Powell LW. Is ultrasonography useful in the assessment of diffuse parenchymal liver disease? Gastroenterology 1985; 89: 186–191.

    PubMed  CAS  Google Scholar 

  26. Burt AD, Mutton A, Day CP. Diagnosis and interpretation of steatosis and steatohepatitis. Semin Diagn Pathol 1998; 15: 246–258.

    PubMed  CAS  Google Scholar 

  27. Schwimmer JB, Behling C, Newbury R et al. Histopathology of Pediatric Nonalcoholic Fatty Liver Disease. Hepatology 2005; 42: 641–649.

    Article  PubMed  Google Scholar 

  28. Xanthokos S, Miles L, Bucuvalas J, Daniels S, Garcia V, Inge T. Histologic spectrum of Nonalcoholic Fatty Liver Disease in Morbidly Obese Adolescents. Clin Gastrol Hepatol 2006; 4: 226–232.

    Article  Google Scholar 

  29. Schwimmer JB, Deutsch R, Rauch JB, Behling C, Newbury R, Lavine JE. Obesity, insulin resistance and other clinicopathological correlates of Pediatric Nonalcoholic fatty liver disease. J Pediatrics 2003; 143: 500–505.

    Article  Google Scholar 

  30. Kerkar N. Non-alcoholic steatohepatitis in children. Pediatr Transplantation 2004; 8: 613–618.

    Article  Google Scholar 

  31. Lavine JE. Vitamin E treatment of nonalcoholic steatohepatitis in children: A pilot study. J Pediatr 2000; 136: 734–738.

    Article  PubMed  CAS  Google Scholar 

  32. Yu AS, Keeffe EB. Nonalcoholic Fatty Liver Disease. Rev Gastroenterol Disord 2002; 2(1): 11–19.

    Google Scholar 

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Correspondence to Narendra K. Arora.

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Mathur, P., Das, M.K. & Arora, N.K. Non-alcoholic fatty liver disease and childhood obesity. Indian J Pediatr 74, 401–408 (2007). https://doi.org/10.1007/s12098-007-0068-0

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  • DOI: https://doi.org/10.1007/s12098-007-0068-0

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