The Indian Journal of Pediatrics

, Volume 80, Supplement 1, pp 109–114 | Cite as

Fatty Liver Disease in Children—What Should One Do?

  • Kristin S. Bramlage
  • Vivek Bansal
  • Stavra A. Xanthakos
  • Rohit Kohli
Symposium on Chronic Noncommunicable Diseases and Children

Abstract

The world’s population is increasingly overweight and obese. According to the World Health Organization (WHO) as of 2010, 43 million children under the age of five were overweight. Once considered to be limited to developed countries, overweight and obese children are now found in low- and middle-income countries, though most commonly in urban areas. Furthermore the WHO now cites the conditions of overweight and obesity as being associated with more deaths around the globe than those associated with being underweight. With this increased prevalence of overweight and obese children has come a host of other medical problems including nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). This review will focus on NAFLD and NASH, their definitions, epidemiology, diagnosis and treatment. The authors will also discuss NAFLD in the Indian subcontinent, and the future of NAFLD and NASH.

Keywords

Obesity Pediatric Nonalcoholic fatty liver disease Nutrition 

Notes

Conflict of Interest

None.

Role of Funding Source

NIH 3K08DK084310 (Salary support to RK); NIH 5T32DK007727 (Salary support to KSB); NIH 5K23DK080888 (salary support to SAX).

References

  1. 1.
    Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc. 1980;55:434–8.PubMedGoogle Scholar
  2. 2.
    Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346:1221–31.PubMedCrossRefGoogle Scholar
  3. 3.
    Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of fatty liver in children and adolescents. Pediatrics. 2006;118:1388–93.PubMedCrossRefGoogle Scholar
  4. 4.
  5. 5.
    de Onis M, Blossner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr. 2010;92:1257–64.PubMedCrossRefGoogle Scholar
  6. 6.
    Das K, Mukherjee PS, Ghosh A, et al. Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease. Hepatology. 2010;51:1593–602.PubMedCrossRefGoogle Scholar
  7. 7.
    Kohli R, Boyd T, Lake K, et al. Rapid progression of NASH in childhood. J Pediatr Gastroenterol Nutr. 2010;50:453–6.PubMedGoogle Scholar
  8. 8.
    Takuma Y, Nouso K. Nonalcoholic steatohepatitis-associated hepatocellular carcinoma: our case series and literature review. World J Gastroenterol. 2010;16:1436–41.PubMedCrossRefGoogle Scholar
  9. 9.
    Ekstedt M, Franzén LE, Mathiesen UL, et al. Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology. 2006;44:865–73.PubMedCrossRefGoogle Scholar
  10. 10.
    Amarapurkar D, Kamani P, Patel N, et al. Prevalence of non-alcoholic fatty liver disease: population based study. Ann Hepatol. 2007;6:161–3.PubMedGoogle Scholar
  11. 11.
    Petersen KF, Dufour S, Feng J, et al. Increased prevalence of insulin resistance and nonalcoholic fatty liver disease in Asian-Indian men. Proc Natl Acad Sci U S A. 2006;103:18273–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Duseja A, Chawla Y. Nonalcoholic fatty liver disease in India—how much? How soon? Trop Gastroenterol. 2005;26:1–3.PubMedGoogle Scholar
  13. 13.
    Banerji MA, Faridi N, Atluri R, Chaiken RL, Lebovitz HE. Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men. J Clin Endocrinol Metab. 1999;84:137–44.PubMedCrossRefGoogle Scholar
  14. 14.
    Manco M, Bedogni G, Marcellini M, et al. Waist circumference correlates with liver fibrosis in children with non-alcoholic steatohepatitis. Gut. 2008;57:1283–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Messiah SE, Arheart KL, Lipshultz SE, Miller TL. Ethnic group differences in waist circumference percentiles among U.S. children and adolescents: estimates from the 1999–2008 national health and nutrition examination surveys. Metab Syndr Relat Disord. 2011;9:297–303.PubMedCrossRefGoogle Scholar
  16. 16.
    Fernandez JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr. 2004;145:439–44.PubMedCrossRefGoogle Scholar
  17. 17.
    Patton HM, Yates K, Unalp-Arida A, et al. Association between metabolic syndrome and liver histology among children with nonalcoholic fatty liver disease. Am J Gastroenterol. 2010;105:2093–102.PubMedCrossRefGoogle Scholar
  18. 18.
    Williams CD, Stengel J, Asike MI, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011;140:124–31.PubMedCrossRefGoogle Scholar
  19. 19.
    Feldstein AE, Charatcharoenwitthaya P, Treeprasertsuk S, Benson JT, Enders FB, Angulo P. The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 y Gut. 2009;58:1538–44.PubMedCrossRefGoogle Scholar
  20. 20.
    Schwimmer JB, Pardee PE, Lavine JE, Blumkin AK, Cook S. Cardiovascular risk factors and the metabolic syndrome in pediatric nonalcoholic fatty liver disease. Circulation. 2008;118:277–83.PubMedCrossRefGoogle Scholar
  21. 21.
    Lavine JE, Schwimmer JB, Van Natta ML, et al. Effect of vitamin E or metformin for treatment of nonalcoholic fatty liver disease in children and adolescents: the TONIC randomized controlled trial. JAMA. 2011;305:1659–68.PubMedCrossRefGoogle Scholar
  22. 22.
    Potter C, Hogan MJ, Henry-Kendjorsky K, Balint J, Barnard JA. Safety of pediatric percutaneous liver biopsy performed by interventional radiologists. J Pediatr Gastroenterol Nutr. 2011;53:202–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Pozzato C, Verduci E, Scaglioni S, et al. Liver fat change in obese children after a 1-y nutrition–behavior intervention. J Pediatr Gastroenterol Nutr. 2010;51:331–5.PubMedGoogle Scholar
  24. 24.
    Engelmann G, Gebhardt C, Wenning D, et al. Feasibility study and control values of transient elastography in healthy children. Eur J Pediatr. 2012;171:353–60.PubMedCrossRefGoogle Scholar
  25. 25.
    Huwart L, Sempoux C, Vicaut E, et al. Magnetic resonance elastography for the noninvasive staging of liver fibrosis. Gastroenterology. 2008;135:32–40.PubMedCrossRefGoogle Scholar
  26. 26.
    Chen J, Talwalkar JA, Yin M, Glaser KJ, Sanderson SO, Ehman RL. Early detection of nonalcoholic steatohepatitis in patients with nonalcoholic fatty liver disease by using MR elastography. Radiology. 2011;259:749–56.PubMedCrossRefGoogle Scholar
  27. 27.
    Alkhouri N, Carter-Kent C, Lopez R, et al. A combination of the pediatric NAFLD fibrosis index and enhanced liver fibrosis test identifies children with fibrosis. Clin Gastroenterol Hepatol. 2011;9:150–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Kohli R, Kirby M, Xanthakos SA, et al. High-fructose, medium chain trans fat diet induces liver fibrosis and elevates plasma coenzyme Q9 in a novel murine model of obesity and nonalcoholic steatohepatitis. Hepatology. 2010;52:934–44.PubMedCrossRefGoogle Scholar
  29. 29.
    Banasch M, Ellrichmann M, Tannapfel A, Schmidt WE, Goetze O. The Non-invasive (13)C-methionine breath test detects hepatic mitochondrial dysfunction as a marker of disease activity in non-alcoholic steatohepatitis. Eur J Med Res. 2011;16:258–64.PubMedCrossRefGoogle Scholar
  30. 30.
    Musso G, Gambino R, Cassader M, Pagano G. A meta-analysis of randomized trials for the treatment of nonalcoholic fatty liver disease. Hepatology. 2010;52:79–104.PubMedCrossRefGoogle Scholar
  31. 31.
    Koot BG, van der Baan-Slootweg OH, Tamminga-Smeulders CL, et al. Lifestyle intervention for non-alcoholic fatty liver disease: prospective cohort study of its efficacy and factors related to improvement. Arch Dis Child. 2011;96:669–74.PubMedCrossRefGoogle Scholar
  32. 32.
    Nobili V, Manco M, Ciampalini P, et al. Metformin use in children with nonalcoholic fatty liver disease: an open-label, 24-m, observational pilot study. Clin Ther. 2008;30:1168–76.PubMedCrossRefGoogle Scholar
  33. 33.
    Chavez-Tapia NC, Tellez-Avila FI, Barrientos-Gutierrez T, Mendez-Sanchez N, Lizardi-Cervera J, Uribe M. Bariatric surgery for non-alcoholic steatohepatitis in obese patients. Cochrane Database Syst Rev. 2010;1:CD007340.PubMedGoogle Scholar
  34. 34.
    Kohli R, Feldstein AE. NASH animal models: are we there yet? J Hepatol. 2011 May 8.Google Scholar
  35. 35.
    Ibrahim SH, Kohli R, Gores GJ. Mechanisms of lipotoxicity in NAFLD and clinical implications. J Pediatr Gastroenterol Nutr. 2011;53:131–40.PubMedCrossRefGoogle Scholar
  36. 36.
    Rotman Y, Koh C, Zmuda JM, Kleiner DE, Liang TJ. The association of genetic variability in patatin-like phospholipase domain-containing protein 3 (PNPLA3) with histological severity of nonalcoholic fatty liver disease. Hepatology. 2010;52:894–903.PubMedCrossRefGoogle Scholar
  37. 37.
    Yajnik CS. The insulin resistance epidemic in India: fetal origins, later lifestyle, or both? Nutr Rev. 2001;59:1–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Esparza-Romero J, Valencia ME, Martinez ME, Ravussin E, Schulz LO, Bennett PH. Differences in insulin resistance in Mexican and U.S. Pima Indians with normal glucose tolerance. J Clin Endocrinol Metab. 2010;95:E358–62.PubMedCrossRefGoogle Scholar
  39. 39.
    Baig U, Belsare P, Watve M, Jog M. Can thrifty gene(s) or predictive fetal programming for thriftiness lead to obesity? J Obes. 2011;2011:861049.PubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2012

Authors and Affiliations

  • Kristin S. Bramlage
    • 1
  • Vivek Bansal
    • 2
  • Stavra A. Xanthakos
    • 1
  • Rohit Kohli
    • 1
  1. 1.Department of Pediatrics, Division of Gastroenterology, Hepatology, and NutritionCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Department of MedicineWoodlands Hospital, National Health GroupWoodlands New TownSingapore

Personalised recommendations