The true prevalence of pediatric nonalcoholic fatty liver disease (NAFLD) is unknown. Challenges in determin ing the population prevalence of NAFLD include the type of test (and the reference intervals used to define ...The true prevalence of pediatric nonalcoholic fatty liver disease (NAFLD) is unknown. Challenges in determin ing the population prevalence of NAFLD include the type of test (and the reference intervals used to define normal and abnormal), the type of population (general population, hospital series), the demographic characteristics of the population sampled, and the nat ure of the study design. The natural history of pediat ric NAFLD remains uncertain. The issue of when to perform a liver biopsy in children with suspected NAFLD remains controversial. Children with NAFLD but normal alanine aminotransferase are rarely investigated. However, evidence of alterations in glucose metabolism parameters should prompt a better understanding of the natural history of pediatric NAFLD not only in terms of the progression of liver disease but also regarding its potential relationship with other health outcomes such as type 2 diabetes mellitus and cardiovascular disease. This evidence could make liver biopsy mandatory in the majority of cases at risk of progressive and severe hepatic and extrahepatic disease. This conclusion, however, raises the question of the feasibility of liver biopsy assessment in an extremely large at risk popul ation, and of the cost/effectiveness of this policy. There is a considerable, continuous interest in reliable, noninv asive alternatives that will allow the prognosis of pediat ric NAFLD to be followed in large community or populat ionbased studies.展开更多
文摘The true prevalence of pediatric nonalcoholic fatty liver disease (NAFLD) is unknown. Challenges in determin ing the population prevalence of NAFLD include the type of test (and the reference intervals used to define normal and abnormal), the type of population (general population, hospital series), the demographic characteristics of the population sampled, and the nat ure of the study design. The natural history of pediat ric NAFLD remains uncertain. The issue of when to perform a liver biopsy in children with suspected NAFLD remains controversial. Children with NAFLD but normal alanine aminotransferase are rarely investigated. However, evidence of alterations in glucose metabolism parameters should prompt a better understanding of the natural history of pediatric NAFLD not only in terms of the progression of liver disease but also regarding its potential relationship with other health outcomes such as type 2 diabetes mellitus and cardiovascular disease. This evidence could make liver biopsy mandatory in the majority of cases at risk of progressive and severe hepatic and extrahepatic disease. This conclusion, however, raises the question of the feasibility of liver biopsy assessment in an extremely large at risk popul ation, and of the cost/effectiveness of this policy. There is a considerable, continuous interest in reliable, noninv asive alternatives that will allow the prognosis of pediat ric NAFLD to be followed in large community or populat ionbased studies.
