Title:Metabolic Associated Fatty Liver Disease in Children and Adolescents:
Mechanisms of a Silent Epidemic and Therapeutic Options
Volume: 20
Issue: 3
Author(s): Antonella Mosca*, Luca Della Volpe, Maria Rita Sartorelli, Donatella Comparcola, Silvio Veraldi, Anna Alisi and Giuseppe Maggiore
Affiliation:
- Hepatogastroenterology, Nutrition, Digestive Endoscopy and Liver Transplantation Unit, IRCCS Bambino Gesù Pediatric Hospital, Rome, Italy
Keywords:
Metabolic Syndrome, NAFL, NASH, uric acid, probiotics, DHA, vitamin D.
Abstract: Non-alcoholic fatty liver disease (NAFLD) is now identified as a hepatic sign of metabolic
syndrome and is the most frequent cause of chronic liver disease in all ages. It is assumed that
a genetic predisposition associated with epigenetic factors participates in the evolution of this condition.
Visceral obesity and insulin resistance (IR) have always been considered the most important
causative factors of Metabolic Syndrome (MetS) and NAFLD, but currently, the interaction between
genetic heritage and environmental factors is increasingly considered fundamental in the
genesis of metabolic disorders associated with NAFLD. In fact, in patients with NAFLD, insulin resistance,
arterial hypertension, abdominal obesity, dyslipidemia and reduced intestinal permeability
have often been found, as well as a higher prevalence of coronary artery disease, obstructive sleep
apnea, polycystic ovary syndrome and osteopenia, which define a MetS framework. Early diagnosis
is needed to prevent disease progression through primarily lifestyle interventions. Unfortunately, at
present, there are no molecules recommended for pediatric patients. However, several new drugs
are in clinical trials. For this reason, targeted studies on the interaction between genetics and environmental
factors involved in the development of NAFLD and MetS and on the pathogenetic mechanisms
that determine the evolution in non-alcoholic steatohepatitis (NASH), should be implemented.
Therefore, it is desirable that future studies may be useful in identifying patients at risk of developing
NAFLD and MetS early.