Nonalcoholic steatohepatitis and insulin resistance in children

Abstract

Various pathological conditions can cause fatty liver in children. Nonalcoholic steatohepatitis (NASH) in children has been known since 1983. However, NASH diagnosed in childhood does not have a favorable outcome. The pathological characteristics of NASH are significantly different between children and adults. Nonalcoholic fatty liver disease (NAFLD)/NASH is accompanied by insulin resistance, which plays a pivotal role in its pathophysiology in both children and adults. In NASH, a "two-hit" model involving triglyceride accumulation (first hit) and liver damage (second hit) has been accepted. Insulin resistance was found to correlate with changes in fat levels; however, it did not correlate with fibrosis or NAFLD activity score in children. Therefore, insulin resistance may be important in the first hit. Because there is obvious familial clustering in NASH, genetic predisposition as well as environmental factors including diet might be the second hit of NAFLD/NASH.

Keywords: Homeostasis model assessment as an index of insulin resistance; Insulin resistance; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; Obesity.

Figure 1

Representative photographs of liver sections of nonalcoholic steatohepatitis/nonalcoholic fatty liver disease patients. A: Pediatric type (type 1) showing severe fibrosis; B: Adult type (type 2) showing mild fibrosis and hepatocyte ballooning.