Nonalcoholic fatty liver disease (
NAFLD) is the most common cause of chronic
liver disease in the pediatric population. Increased recognition of this form of
liver disease parallels the dramatic rise in childhood and
adolescent obesity over the past 2 decades. Like adults, most children with
NAFLD are obese, and comorbidities include
insulin resistance,
hypertension, and
dyslipidemia. Unfortunately, pediatric
NAFLD is not always a benign condition, with some children progressing to hepatic
fibrosis and even
cirrhosis in severe cases. The etiology of
nonalcoholic steatohepatitis is not yet fully understood; however, hepatic steatosis in the context of
insulin resistance and increased oxidative stress may lead to progressive disease. Although physical examination, laboratory evaluation, and radiographic findings provide clues to the potential presence of
fatty liver disease, liver biopsy remains the gold standard for diagnosis. Lifestyle modification, including slow and steady
weight loss, improved dietary habits, and increased daily, aerobic physical activity, remains the first-line approach in treating pediatric
fatty liver disease.
Antioxidant pharmacologic
therapy such as use of
vitamin E has shown some benefit in patients with biopsy-proven
steatohepatitis. Nutrition plays an essential role not only in the development of
fatty liver disease but also potentially in the treatment and prevention of progression to more severe disease.