Review Article

The Management of Paediatric Nonalcoholic Fatty Liver Disease

E. B. Mitchel; J. E. Lavine

Disclosures

Aliment Pharmacol Ther. 2014;40(10):1155-1170. 

In This Article

Conclusions

Nonalcoholic fatty liver disease is the most common cause of chronic liver disease in paediatric patients. Given the increasing prevalence of NAFLD in the paediatric population it is likely that future downstream morbidity including end-stage liver disease and cardiometabolic conditions will be increasing. While clinical trials have been performed in children and adolescents, there is continuing need for data regarding the long-term natural history and utility of various interventions in children. Multidisciplinary team utilising primary providers, liver specialists, surgeons, endocrinologists and dieticians should be engaged. First-line therapy requires reinforced lifestyle intervention with formalised instruction regarding diet and exercise. This prescription should engage the family in regards to food selection and quantity as well as local resources providing age- and gender-sensitive physical recreation. The beneficial effects of medical therapies such as cysteamine bitartrate, probiotics, supplemental polyunsaturated fats and pentoxyfylline have been reported in children and adults (Table 1). Larger, randomised clinical trials need to be performed. Vitamin E taken 800 IU orally per day has been shown in paediatric and adult RCTs to significantly improve important histological outcomes in NASH without reported problems. Thus, vitamin E should be considered as a treatment for any child with biopsy demonstrated NASH or borderline NASH failing first-line therapy. Finding the optimal dose and duration for treatment is a lingering need. As knowledge in the field of paediatric NAFLD expands and understanding of the pathogenesis unfolds, directing therapeutic interventions to specific individual predilections will yield increasingly effective results.

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