Paediatric Nonalcoholic Fatty Liver Disease

Anna Alisi; Guido Carpino; Valerio Nobili


Curr Opin Gastroenterol. 2013;29(3):279-284. 

In This Article


Paediatric NAFLD presents the same basic morphological features observed in its adult counterpart even if with a different distribution pattern.

Histologicical Features of Paediatric Nonalcoholic Fatty Liver Disease

Characterization of the histological features in children is central both for diagnosis and management of NAFLD. Classical histological features that characterize paediatric NAFLD include steatosis, ballooning, inflammation and fibrosis.[3,8]

The presence of steatosis in more than 5% of hepatocytes is the minimum criterion for the diagnosis of NAFLD. Tissue distribution of steatosis in paediatric NAFLD is distinctive, because it initially involves a periportal zone (acinar zone 1) or displays an azonal distribution.[9]

Although lobular inflammation is another major component of NASH, it is rare in children, who more frequently present inflammation in only the portal tract.[10]

Ballooning is the most relevant morphological sign of damaged hepatocytes, whereas fibrosis is the manifestation of the most severe organ damage in NASH. Children with NASH prevalently exhibit a pattern of portal-periportal fibrosis, with the possible presence of perisinusoidal fibrosis.[8,11]

NASH pattern in children is heterogeneous. In fact, children may alternatively exhibit features of the type 1, type 2 or overlapping NASH, raising some scepticism about its factual origin. Interestingly, the several discrepancies which have been found in the distribution of the different types of NASH in children are strongly correlated to sex and ethnicity.[12]