Review
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World J Hepatol. Jul 27, 2010; 2(7): 275-288
Published online Jul 27, 2010. doi: 10.4254/wjh.v2.i7.275
Pediatric nonalcoholic fatty liver disease: A clinical and laboratory challenge
Lucia Pacifico, Eleonora Poggiogalle, Vito Cantisani, Guendalina Menichini, Paolo Ricci, Flavia Ferraro, Claudio Chiesa
Lucia Pacifico, Eleonora Poggiogalle, Flavia Ferraro, Claudio Chiesa, Departments of 1 Pediatrics, Sapienza University of Rome, Rome 00161, Italy
Vito Cantisani, Guendalina Menichini, Paolo Ricci, Departments of Radiological Sciences, Sapienza University of Rome, Rome 00161, Italy
Lucia Pacifico, Claudio Chiesa, National Research Council, Institute of Neurobiology and Molecular Medicine, Rome 00133, Italy
Author contributions: Pacifico L, Poggiogalle E, and Chiesa C designed the study; Menichini G and Ferraro F were responsible for the review of the literature; Cantisani V and Ricci P analyzed the data and were responsible for the initial preparation of the paper;and Pacifico L and Chiesa C prepared the final version of the manuscript.
Correspondence to: Claudio Chiesa, MD, Institute of Neurobiology and Molecular Medicine, National Research Council, Via del Fosso del Cavaliere, Rome 100 00133, Italy. claudio.chiesa@artov.inmm.cnr.it
Telephone: +39-6-49979215 Fax: +39-6-49979216
Received: December 23, 2009
Revised: July 6, 2010
Accepted: July 13, 2010
Published online: July 27, 2010
Abstract

The true prevalence of pediatric nonalcoholic fatty liver disease (NAFLD) is unknown. Challenges in determining the population prevalence of NAFLD include the type of test (and the reference intervals used to define normal and abnormal), the type of population (general population, hospital series), the demographic characteristics of the population sampled, and the nature of the study design. The natural history of pediatric NAFLD remains uncertain. The issue of when to perform a liver biopsy in children with suspected NAFLD remains controversial. Children with NAFLD but normal alanine aminotransferase are rarely investigated. However, evidence of alterations in glucose metabolism parameters should prompt a better understanding of the natural history of pediatric NAFLD not only in terms of the progression of liver disease but also regarding its potential relationship with other health outcomes such as type 2 diabetes mellitus and cardiovascular disease. This evidence could make liver biopsy mandatory in the majority of cases at risk of progressive and severe hepatic and extrahepatic disease. This conclusion, however, raises the question of the feasibility of liver biopsy assessment in an extremely large at risk population, and of the cost/effectiveness of this policy. There is a considerable, continuous interest in reliable, noninvasive alternatives that will allow the prognosis of pediatric NAFLD to be followed in large community or population-based studies.

Keywords: Nonalcoholic fatty liver disease; Children; Insulin resistance; Ultrasound; Magnetic resonance imaging