PERSONAL PRACTICE

Fatty liver disease in children

A W Marion, A J Baker and A Dhawan

Paediatric Liver Service, King’s College Hospital, London, UK

Correspondence to:
Correspondence to:
Dr A Dhawan
Paediatric Liver Service, King’s College Hospital, Denmark Hill, London SE5 9RY, UK; anil.dhawan{at}kcl.ac.uk

NAFLD/NASH is now recognised as an increasing clinical problem in children and adolescents. Risk factors include obesity, insulin resistance, and hypertriglyceridaemia. Drug hepatoxicity and genetic or metabolic diseases that can cause hepatic steatosis must be excluded. Affected children are usually asymptomatic although a few may complain of malaise, fatigue, or vague recurrent abdominal pain. Liver biopsy is the gold standard for diagnosis, and is important in determining disease severity and prognosis. The natural history of childhood NASH may be progressive liver disease for a significant minority. Long term follow up studies in this population are still lacking. The mainstay of treatment is weight reduction. The use of pharmacological therapy, though promising, ideally needs further evaluation in well designed randomised controlled studies in children.

Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; FFA, free fatty acids; NAFLD, non-alcoholic fatty liver disorders; NASH, non-alcoholic steatohepatitis; NIDDM, non-insulin dependent diabetes mellitus; VLDL, very low density lipoproteins

Keywords: NASH; cirrhosis; fatty liver; obesity; steatohepatitis

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