Paediatric Nonalcoholic Fatty Liver Disease

Anna Alisi; Guido Carpino; Valerio Nobili


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

In This Article

Diagnostic Routes for Paediatric Nonalcoholic Steatohepatitis

The epidemic proportion of paediatric NAFLD prevalence, together with the evidence of its long-term effect on severe organ damage, emphasizes the need for a precise and early diagnosis. Fortunately, this last year has been highly successful in this regard. In fact, both European and American associations have proposed their guidelines for diagnosis of paediatric NAFLD.[37,38] There are several common elements among the two management plans. As for adults, children and adolescents with persistently altered (>6 months) liver function tests should be tested for alternative causes of liver disease before proceeding with the diagnostic flowchart for NAFLD. Definite diagnosis of paediatric NAFLD requires liver biopsy, at least before starting the therapy. However, as in adults, the use of noninvasive biomarkers or imaging techniques to identify those individuals at a risk for more rapid progression or severe disease, and for the screening of response to lifestyle interventions and/or pharmacological treatments is recommended. However, the position paper of the ESPGHAN is more clear about diagnostic steps required for children with suspected NAFLD. As reported in Fig. 1, the diagnostic algorithm for paediatric NAFLD includes abdominal ultrasound and liver function tests, followed by the exclusion of other liver diseases; high-risk children (overweight/obese) with normal ultrasound liver function tests should still be monitored; liver biopsy is recommended in cases of clinically suspected advanced liver disease, before therapy, and as part of clinical research trial.

Figure 1.

Diagnostic flowchart based on the ESPGHAN practice guideline for nonalcoholic fatty liver disease.

Scores for Paediatric Nonalcoholic Fatty Liver Disease

Scores for paediatric NAFLD are of two types: the paediatric NAFLD fibrosis index (PNFI) that, based on anthropometrics (age and waist circumference) and on noninvasive serum markers (triglycerides), is able to predict liver fibrosis risk in children with NAFLD;[39] and the very new Paediatric NAFLD Histological Score or PNHS that, with an excellent correlation to NASH presence, is the optimal choice for histological grading of NAFLD in children.[40]