Pediatric Non-alcoholic Fatty Liver Disease

Childhood obesity has reached epidemic proportions, and by 2012, more than one third of American children were overweight or obese. As a result, increasingly, children are developing complications of obesity including liver disease. In fact, non-alcoholic fatty liver disease is the most common form of chronic liver disease seen in children today. Recently, there has been a burgeoning literature examining the pathogenesis, genetic markers, and role of the microbiome in this disease. On the clinical front, new modalities of diagnosing hepatic steatosis and hepatic fibrosis are being developed to provide non-invasive methods of surveillance in children. Lastly, the mainstay of treatment of pediatric non-alcoholic fatty liver disease (NAFLD) has been largely through lifestyle interventions, namely, dieting and exercise. Currently, there are a number of clinical trials examining novel lifestyle and drug therapies for NAFLD that are registered with the US National Institutes of Health ClinicalTrials.gov website.     

Nonalcoholic Fatty Liver Disease: A Review and Update

The spectrum of nonalcoholic fatty liver disease (NAFLD) ranges from asymptomatic steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. Hepatic steatosis occurs when free fatty acids, released in the setting of insulin resistance and the metabolic syndrome, are taken up by the liver. Additional biochemical insults, including oxidative stress, upregulation of inflammatory mediators, and dysregulated apoptosis, can result in inflammation (producing NASH) and fibrosis. Noninvasive methods (e.g., abdominal ultrasonography) are safe ways to support a diagnosis of hepatic steatosis, but advanced liver histopathologic findings including NASH and fibrosis cannot be identified without pursuing liver biopsy. Recent advances in serologic and imaging methods aim to determine severity of inflammation and fibrosis noninvasively. Currently, therapeutic options for NAFLD are limited to medications that reduce risk factors, but the future holds promise for therapies that might slow the progression of this increasingly prevalent disorder.     

Pregnancy and Metabolic-associated Fatty Liver Disease: A Clinical Update

The intricate relationship between metabolic-associated fatty liver disease (MAFLD) and maternal complications has rapidly become a significant health threat in pregnant women. The presence of MAFLD in pregnancy increases the maternal risk of metabolic complications and comorbidities for both mother and baby. The preexistence or development of MAFLD in pregnancy is a complex multifactorial disorder that can lead to further complications for mother and baby. Therefore, as pregnant women are severely underrepresented in clinical research, there is a great need for a fair inclusion of this group in clinical trials. This review aims to explore the effects of MAFLD during pregnancy in the context of maternal complications and outcomes and explore the effects of pregnancy on the development and progression of MAFLD within the context of maternal obesity, altered metabolic profiles, gestational diabetes and altered hormonal profiles. We also addressed potential implications for the presence of MAFLD during pregnancy and its management in the clinical setting.     

Drug-Induced Fatty Liver Disease

Purpose of Review

Drug-induced fatty liver disease (DIFLD) is one of the manifestations of drug-induced liver injury (DILI) based on histopathology findings of steatosis or steatohepatitis. DIFLD has high semblance to nonalcoholic fatty liver disease (NAFLD), where similar histopathological features are seen. As NAFLD is a commonly occurring disease, differentiating DIFLD from NAFLD requires a thorough history of medication use. Outcomes in DIFLD vary with the clinical presentation, with extremely high mortality in acute fatty liver presentations and indolent course in the rest. Pathophysiology in almost all cases of DIFLD encompasses one of the following: increased uptake or decreased output of triglycerides from hepatocytes or decreased metabolism of triglycerides (such as fatty acid oxidation) or electron transport chain. DIFLD may present as acute fatty liver or more commonly as indolent fatty liver disease. In this article, we outline pathophysiology, diagnosis, management, and common medications associated with DIFLD.

Recent Findings

Recent findings give insights into new technologies that may help us understand common pathways that are associated with drugs that cause and factors that modify susceptibility to DIFLD. Latest research has also allowed for identification of genetic polymorphisms associated with increased risk for DIFLD using genome-wide association studies (GWAS).

Summary

Drugs associated with DIFLD may have distinct clinical presentations, disease progression, and outcomes, timely identification of which is crucial to clinical management. We provide a succinct read for anyone interested in DIFLD phenotype of DILI, pathophysiology, clinical presentation, and management.

     

脂肪性肝病的肝移植

随着肥胖症发病率在美国乃至全球的持续上升,非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH）的诊断日益增多,并被认为是终末期肝病（ESLD）的病因之一。     

Biomarkers of Metabolic (Dysfunction)-associated Fatty Liver Disease: An Update

The prevalence of metabolic (dysfunction)-associated fatty liver disease (MAFLD) is rapidly increasing and affects up to two billion individuals globally, and t...     

Intensive Lifestyle Management Improves Steatosis and Fibrosis in Pediatric Nonalcoholic Fatty Liver Disease

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