Pediatric Fatty Liver Disease
NAFLD is the most common chronic liver disease across all age groups with a prevalence of 9.6% in lean and 38% to 45% in obese children, respectively. It is commonly seen in small-for-gestationalage and large-for-gestational-age infants, and children born by obese or diabetic mothers. It should be suspected in obese ≥9 years of children, overweight children with a family history of NAFLD, or with cardiometabolic risk factors. For diagnosis, ALT levels are tested for initial screening, which can be later confirmed with vibration-controlled transient elastography. Some of the tips to manage pediatric fatty liver disease are:
- Counseling against binge drinking, smoking, use of electronic nicotine delivery device.
- Families of children with NAFLD should be counseled about the risk of second-hand smoking exposure.
- Ensure protection against Hep A and B.
- Lifestyle modifications: Encouraging a balanced and healthy diet, regular moderate to high-intensity physical activity, avoiding sugar-sweetened beverages and limiting screen time.
- Medications: No proven therapy.
- Bariatric surgery can be considered in select patients. Hereditary fructose intolerance, lysosomal acid lipase deficiency, dyslipidemia, citrin deficiency and Wilson disease may present as fatty liver. But they should be seen as a red flag to prevent any future morbidity.
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