Nonalcoholic Steatohepatitis: Case-Based Focused on Pediatric and Adult Guidelines

Nonalcoholic fatty liver disease (NAFLD) comprises a continuum of conditions associated with insulin resistance and obesity in the absence of secondary causes of hepatic steatosis (alcohol, medication, genetic disorders, hepatitis, etc.) The milder, benign form of NAFLD is simple fatty liver or steatosis. Fatty infiltration affects more than 5% of the liver.1 This is determined by histologic exam, direct quantification or imaging. The range progresses to nonalcoholic steatohepatitis (NASH) and culminates in fibrosis and cirrhosis. Histologic changes include ballooning degeneration of hepatocytes, the presence of Mallory bodies, macrovesicular steatosis, lobular or portal inflammation.2 NAFLD is now the foremost cause of childhood, adolescent and adult chronic hepatic disease. The pediatric and adult obesity epidemic makes NAFLD a potentially ubiquitous hepatic pathology amongst all patients.3,4,5The increase of obese children and adults with obesity correlates to the rise of NAFLD cases. In adults, the rate of NAFLD increase is paired with the epidemics of obesity and Type 2 Diabetes (T2DM).4,5 Data proposes hepatic-related mortality may be due to NASH ultimately progressing to cirrhosis.3,4 NAFLD is linked to pediatric and adult cardiovascular risk and morbidity.4,6Non-invasive biomarkers and the gold standard of liver biopsy not only diagnose but assist in targeted therapies.6 Most pharmacologic therapy for NAFLD is in trial stages for patients of all ages. Pioglitazone is favored in adults who have NAFLD/NASH and T2DM.7 The gut biome is also impactful. Lifestyle modifications of diet and exercise can reduce the public health burden of this disease.7,8,9,10

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Current Status in Testing for Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH)

Cells ◽

10.3390/cells8080845 ◽

2019 ◽

Vol 8 (8) ◽

pp. 845 ◽

Cited By ~ 26

Author(s):

Hannah Drescher ◽

Sabine Weiskirchen ◽

Ralf Weiskirchen

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Nonalcoholic Steatohepatitis ◽

Fatty Liver Disease ◽

Sampling Error ◽

Imaging Techniques ◽

Current Status ◽

Nonalcoholic Fatty Liver ◽

Public Health Burden

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in Western countries with almost 25% affected adults worldwide. The growing public health burden is getting evident when considering that NAFLD-related liver transplantations are predicted to almost double within the next 20 years. Typically, hepatic alterations start with simple steatosis, which easily progresses to more advanced stages such as nonalcoholic steatohepatitis (NASH), fibrosis and cirrhosis. This course of disease finally leads to end-stage liver disease such as hepatocellular carcinoma, which is associated with increased morbidity and mortality. Although clinical trials show promising results, there is actually no pharmacological agent approved to treat NASH. Another important problem associated with NASH is that presently the liver biopsy is still the gold standard in diagnosis and for disease staging and grading. Because of its invasiveness, this technique is not well accepted by patients and the method is prone to sampling error. Therefore, an urgent need exists to find reliable, accurate and noninvasive biomarkers discriminating between different disease stages or to develop innovative imaging techniques to quantify steatosis.

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1450-P: High Risk of Mortality and Disease Progression Associated with Diabetes Mellitus (DM) and Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis (NAFLD/NASH) in Medicare Patients

Diabetes ◽

10.2337/db19-1450-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 1450-P

Author(s):

ROHIT LOOMBA ◽

JEREMY FRAYSSE ◽

SUYING LI ◽

A. BURAK OZBAY ◽

STEPHEN A. HARRISON

Keyword(s):

Diabetes Mellitus ◽

Liver Disease ◽

High Risk ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Nonalcoholic Steatohepatitis ◽

Fatty Liver Disease ◽

Nonalcoholic Fatty Liver ◽

Risk Of Mortality ◽

Medicare Patients

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New therapy for fatty liver

Thai Journal of Hepatology ◽

10.30856/th.jhep2018vol1iss2_06 ◽

2018 ◽

Vol 1 (2) ◽

pp. 24-28

Author(s):

Tanita Suttichaimongkol

Keyword(s):

Oxidative Stress ◽

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Lifestyle Modifications ◽

Alcoholic Fatty Liver ◽

Nonalcoholic Fatty Liver ◽

Liver Insulin Resistance ◽

Alcoholic Fatty Liver Disease ◽

Related Mortality

Non-alcoholic fatty liver disease (NAFLD) is a leading cause of death from liver cirrhosis, endstage liver disease, and hepatocellular carcinoma. It is also associated with increased cardiovasculardisease and cancer related mortality. While lifestyle modifications are the mainstay of treatment,only a proportion of patients are able to make due to difficult to achieve and maintain, and so moretreatment options are required such as pharmacotherapy. This review presents the drugs used inmanaging NAFLD and their pharmacologic targets. Therapies are currently directed towards improvingthe metabolic status of the liver, insulin resistance, cell oxidative stress, apoptosis, inflammation orfibrosis. Several agents are now in large clinical trials and within the next few years, the availability oftherapeutic options for NAFLD will be approved. Keywords: nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, fibrosis, cirrhosis

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Faculty Opinions recommendation of Prothrombotic factors in histologically proven nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718219728.793492165 ◽

2014 ◽

Author(s):

Stephen Stewart ◽

Audrey Dillon

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Nonalcoholic Steatohepatitis ◽

Fatty Liver Disease ◽

Nonalcoholic Fatty Liver

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Cardiovascular Risk in Children with Nonalcoholic Fatty Liver Disease (NAFLD)

Current Pediatric Reviews ◽

10.2174/1573396316666201009154913 ◽

2020 ◽

Vol 16 ◽

Author(s):

Anna Bobrus- Chociej ◽

Natalia Wasilewska ◽

Marta Flisiak- Jackiewicz ◽

Dariusz Lebensztejn

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Fatty Liver Disease ◽

Current Knowledge ◽

Scientific Evidence ◽

Multisystem Disorder ◽

Nonalcoholic Fatty Liver ◽

Obesity Epidemic ◽

The Metabolic Syndrome

: Nonalcoholic fatty liver disease (NAFLD) is a main cause of chronic liver disease in children. With the global obesity epidemic, the prevalence of NAFLD is increasing both in industrialized and developing countries. NAFLD is a multisystem disorder and a hepatic manifestation of the metabolic syndrome. Growing scientific evidence suggests that NAFLD is an independent risk factor for cardiovascular disease. This paper briefly describes the current knowledge concerning the association between NAFLD and cardiac dysfunction in children.

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