The urgent need for treating liver disease in obese children

Experts call for research on the treatment of non-alcoholic fatty liver disease, the most common form of chronic liver disease in children.

In a new review, a group of international scientists evaluated the risk factors, diagnosis and treatment of non-alcoholic fatty liver disease (NAFLD), the most common form of chronic liver disease in children with metabolic syndrome (1). According to the latest research, several factors can contribute to NAFLD development, including race/ethnicity, genetic factors and environmental exposures. Diagnosing advanced disease, potentially leading to liver fibrosis and cirrhosis, is challenging and may require a liver biopsy, highlighting the urgent need for reliable, noninvasive markers of disease severity. The mainstay of treatment for NAFLD remains lifestyle modifications and weight loss. Studies indicated that omega-3 fatty acids may ameliorate disease progression (2) and that vitamin E may be considered as a non-alcoholic fatty liver disease-specific therapy in children (3).

The researchers noted that NAFLD is increasingly becoming a concern among pediatricians and is being seen in younger children due to the rise of the obesity epidemic. Given the relationship between lifestyle choices and NAFLD and considering the role of oxidative stress in the pathology of NAFLD, researchers have been investigating the use of vitamin E supplementation on ameliorating this problem. In adults, vitamin E supplementation has been shown to improve outcomes in patients with more advanced liver disease (4). Data in children, however, have been slightly mixed, yet still hold the potential to show a benefit with further research (3). With over one-third of American children being classified as overweight or obese, there is increasing awareness of the consequences of the childhood obesity epidemic. NAFLD is one such consequence in which fat accumulates in the liver, resulting in inflammation and disruptions in liver function, with the potential to result in liver failure.

1. Nobili V. et al. Nonalcoholic Fatty Liver Disease: A Challenge for Pediatricians. JAMA Pediatr. Published online December 2014.
2. Yang M. et al. Non-alcoholic fatty liver disease in children: focus on nutritional interventions. Nutrients. 2014; 6(11):4691–4705.
3. Sarkhy A. et al. Does vitamin E improve the outcomes of pediatric nonalcoholic fatty liver disease? A systematic review and meta-analysis. Saudi J Gastroenterol. 2014; 20(3):143–153.
4. Sanyal A. J. et al. Pioglitazline, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med. 2010; 362(18):1675–1685.