Nonalcoholic fatty liver disease in children

Purpose of review Nonalcoholic fatty liver disease (NAFLD) has become the most common cause of liver disease in children from the developed world. The purpose of this review is to provide both a focused overview of pediatric NAFLD as well as a summary of the most recent advancements in the field. Recent findings Pediatric NAFLD is an underdiagnosed condition which can result in significant liver injury including cirrhosis. Although liver biopsy remains the standard for diagnosis and monitoring disease activity, several noninvasive biomarkers and imaging techniques hold significant promise. Dietary constituents, the intestinal bacterial flora, and sex hormones have been implicated as modulators of disease activity. NAFLD predisposition runs strongly in families and an allele in the PNPLA3 gene has shown a strong association with liver steatosis and hepatic inflammation. Treatment for pediatric NAFLD remains diet and exercise, but vitamin E may be a helpful adjunct. Summary Pediatric NAFLD shares many features with its adult counterpart but is a distinct entity which requires independent investigation. Our understanding of NAFLD in terms of epidemiology and risk factors has improved considerably but significantly more investigation is required to unravel its pathophysiology and identify novel therapeutic targets.