Paediatric Non Alcoholic Fatty Liver Disease (NAFLD) on the Context of the Global Epidemic of Obesity.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease of adults and children worldwide. NAFLD is a spectrum of disease, from simple hepatic steatosis to nonalcoholic steatohepatitis (NASH) which may progress to fibrosis, ultimately leads to cirrhosis. Non-alcoholic fatty liver disease (NAFLD) means the presence of 5% or more hepatic steatosis as diagnosed by liver imaging or liver biopsy in the absence of secondary hepatic fat accumulation. In North American studies, NAFLD prevalence is 29.0%-38.0% in obese children (by screening of enzyme elevation and also by autopsy study). For children, the incidence and prevalence of NAFLD have been increased dramatically over the last few years. Obviously, obesity epidemic plays the most important role. Insulin resistance is the primary and most important factor for the development of NAFLD. Patients with NAFLD often have associated extrahepatic diseases such as obesity, type 2 diabetes, metabolic syndrome and cardiovascular diseases. Screening for NAFLD is currently suggested for all obese children 9 years or older as defined by a BMI above the 95th percentile and should also be considered for overweight children with a family history of NAFLD or the presence of added risk factors. Serum Alanine aminotransferase is the recommended first screening test for NAFLD and interpretation should be based on sex-specific reference ranges (normal value -ALT <26 U/L in males and <22 U/L in females). Various imaging studies are done for diagnosis of NAFLD, such as ultrasonography, Vibration-controlled transient elastography, Magnetic resonance elastrography (MRE). Still, liver biopsy is the gold standard for the confirmation of NAFLD. New promising noninvasive biomarkers and imaging techniques are used for diagnosis for NAFLD. The most important treatment strategy for NAFLD involves lifestyle changes which includes dietary modification and physical exercise. Presently, no medications are approved by the US Food and Drug Administration (FDA) for the treatment of NAFLD in children.