Gastroenterologìa (Apr 2015)
Non-Alcoholic Fatty Liver Disease in Children: Current View on Diagnostics and Treatment (Part I)
Abstract
Non-alcoholic fatty liver disease (NAFLD) is deemed to be the leading cause of chronic liver disease in children and adolescents in industrialized countries. NAFLD is associated with abdominal obesity, insulin resistance, carbohydrate intolerance and dyslipidemia; it is relative to metabolic syndrome and is its manifestation. Study data have shown that NAFLD has a higher overall mortality rate and high probability of developing cardiovascular disease, that is not dependent on the presence of classical risk factors of atherosclerosis. The monitoring of the course of the disease over the past 20 years has established a reduction in the duration of survival of patients with NAFLD compared with the expected rate in the general population, the progression of fibrosis in 80 % of cases, the development of decompensated forms of cirrhosis requires the transplantation in 6 % of patients. The tendency to progression of structural changes in the liver with the development of the terminal stages of the disease — cirrhosis and hepatocellular carcinoma, the risk of developing cardiovascular complications, possibility of preventing progredient course in timely therapeutic intervention necessitate early diagnosis of NAFLD in children. The leading constitutional risk factors of NAFLD that could be modified in the children are obesity and insulin resistance. The mechanism of NAFLD development and progression is a complex and multifactorial process. Nowadays there are two basic concepts that explain the pathogenesis of NAFLD — «two-hits» theory and «multiple parallel hits» theory. NAFLD in children has no specific clinical signs and is an accidental finding among asymptomatic patients. The manifestation of the disease occurs mostly over the age of 10 years old. There are nonspecific symptoms in the clinical picture of NAFLD in children — general weakness, rapid fatigability, exhaustion. Usually, the first step in the diagnosis of the disease is detection of elevated hepatic transaminases and/or sonographic signs of steatosis by routine clinical ultrasound. The diagnosis of NAFLD is possible in the absence of signs of liver injury of another nature, first of all autoimmune and drug-induced hepatitis.
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