Non-alcoholic fatty liver disease in childhood and adolescence

Childhood obesity is a worldwide epidemic. There are several comorbidities associated with obesity, including non-alcoholic fatty liver disease (NAFLD), a wide term that ranges from a hepatocellular steatosis to more advanced steatohepatitis, fibrosis and liver cirrhosis. This is the second major cause of liver transplant in adults in the United States, with the potential to become the first one in the next few decades. Associated with this scenario, the challenge of diagnosis still exists, since screening is still controversial, especially in children. Biopsy is the gold standard, but it is an invasive and risky procedure. Therefore liver enzymes and abdominal ultrasound are used for screening and assessment although their limitations. Treatment of NAFLD should involve an approach to obesity with focus in lifestyle intervention and healthy diet. While the efficacy of several medications has been investigated in children, healthy diet and physical activity remain the only prevention and treatment strategies for paediatric NAFLD. A multidisciplinary team should, together with the patient and a family, build a routine of healthy eating and physical activities. (author)