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Review
. 2020 Sep 17;3(4):e00184.
doi: 10.1002/edm2.184. eCollection 2020 Oct.

Perspectives on youth-onset nonalcoholic fatty liver disease

Eduardo Castillo-Leon  1 , Catherine E Cioffi  1   2 , Miriam B Vos  1   3
Affiliations
Review

Perspectives on youth-onset nonalcoholic fatty liver disease

Eduardo Castillo-Leon et al. Endocrinol Diabetes Metab. .

Abstract

Background: The prevalence and incidence of youth-onset nonalcoholic fatty liver disease (NAFLD) far exceeds other paediatric chronic liver diseases and represents a considerable public health issue globally.

Methods: Here, we performed a narrative review of current knowledge regarding the epidemiology of paediatric NAFLD, selected concepts in pathogenesis, comorbidities, diagnosis, and management, and issues related to the transition to adulthood.

Results: Paediatric NAFLD has become increasingly more prevalent, especially in certain subgroups, such as children with obesity and certain races/ethnicities. The pathophysiology of paediatric NAFLD is complex and multifactorial, driven by an interaction of environmental and genetic factors. Once developed, NAFLD in childhood is associated with type 2 diabetes, hypertension, increased cardiovascular disease risk, and end-stage liver disease. This predicts an increased burden of morbidity and mortality in adolescents and young adults. Early screening and diagnosis are therefore crucial, and the development of noninvasive biomarkers remains an active area of investigation. Currently, treatment strategies are focused on lifestyle changes, but there is also research interest in pharmacological and surgical options. In the transition from paediatric to adult care, there are several potential challenges/barriers to treatment and research is needed to understand how best to support patients during this time.

Conclusions: Our understanding of the epidemiology and pathophysiology of paediatric NAFLD has increased considerably over recent decades, but several critical knowledge gaps remain and must be addressed in order to better mitigate the short-term and long-term risks of youth-onset NAFLD.

Keywords: children; nonalcoholic fatty liver disease; type 2 diabetes.

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Conflict of interest statement

MV has consulting arrangements with Boehringer Ingelheim, Bristol Myers Squibb, Intercept, Mallinckrodt, Novo Nordisk and TARGET PharmaSolutions and research funding from TARGET PharmaSolutions and Bristol Myers Squibb.

Figures

FIGURE 1
FIGURE 1
The whole child perspective. A summary of the potential health risks and comorbidities that may occur in children with youth‐onset NAFLD. NAFLD, Nonalcoholic fatty liver disease; PCOS, polycystic ovary syndrome
FIGURE 2
FIGURE 2
Schematic summary of the current screening guidelines for identifying children who may need further evaluation for youth‐onset NAFLD. ALT, alanine aminotransferase; NAFLD, Nonalcoholic fatty liver disease; y, years
See this image and copyright information in PMC

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