Topic Highlight
Copyright ©2010 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 14, 2010; 16(42): 5280-5285
Published online Nov 14, 2010. doi: 10.3748/wjg.v16.i42.5280
Pediatric nonalcoholic fatty liver disease: Overview with emphasis on histology
Yoshihisa Takahashi, Toshio Fukusato
Yoshihisa Takahashi, Toshio Fukusato, Department of Pathology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
Author contributions: Takahashi Y wrote the paper; Fukusato T checked and revised the manuscript.
Correspondence to: Yoshihisa Takahashi, MD, Department of Pathology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan. ytakaha-tky@umin.ac.jp
Telephone: +81-3-39641211 Fax: +81-3-39649622
Received: March 26, 2010
Revised: May 25, 2010
Accepted: June 2, 2010
Published online: November 14, 2010
Abstract

Nonalcoholic fatty liver disease (NAFLD) is a disease in which excessive fat accumulates in the liver of a patient without a history of alcohol abuse. This disease includes simple steatosis and nonalcoholic steatohepatitis (NASH). NAFLD/NASH is recognized as a hepatic manifestation of metabolic syndrome. In recent years, pediatric NAFLD has increased in line with the increased prevalence of pediatric obesity. The estimated prevalence of pediatric NAFLD is 2.6%-9.6%, and it is associated with sex, age, and ethnicity. With regard to the pathogenesis of NAFLD, the “two-hit” hypothesis is widely accepted and oxidative stress is thought to play an important role in the second hit. Although clinical symptoms, laboratory data, and imaging findings are important, liver biopsy is regarded as the gold standard for the diagnosis of NAFLD/NASH. In addition, liver biopsy is essential for assessing the degree of necro-inflammatory change and fibrosis in NASH. Two different types of steatohepatitis (type 1 and type 2 NASH) have been reported, with type 2 NASH being present in as many as 51% of pediatric NAFLD patients. However, we and others have observed that type 1 and 2 patterns commonly overlap. Although pharmacotherapy has been studied in clinical trials, lifestyle modification by diet and exercise remains the mainstay of treatment for NAFLD/NASH.

Keywords: Children; Histology; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; Obesity