Sweeny Katherine F, Lee Christine K
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
Gastroenterol Hepatol (N Y). 2021 Dec;17(12):579-587.
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. It represents a spectrum of disease from simple hepatic steatosis to steatohepatitis that may develop into progressive hepatic fibrosis and even cirrhosis. NAFLD is the most rapidly increasing indication for liver transplantation in adults. In children, the incidence of NAFLD has also increased over the past decade. Although the majority of children with NAFLD are overweight or obese, there is an increasing subset of children with normal body mass index with so-called lean NAFLD. NAFLD in children is associated with several extrahepatic manifestations, including hyperlipidemia, insulin resistance, and obstructive sleep apnea. The pathogenesis of NAFLD in children involves a multifactorial interaction among genetics, in utero exposures, early childhood exposures, and ongoing nutritional exposures. Although there are some similarities between pediatric NAFLD and adult NAFLD, liver biopsies in children show histologic differences between the two. The current standard-of-care treatment of NAFLD in children is lifestyle change to decrease caloric intake and increase physical activity. There are no medications currently approved for the treatment of NAFLD in children. This article aims to summarize the current understanding of pediatric NAFLD and future directions for intervention and therapeutic aims.
非酒精性脂肪性肝病（NAFLD）是全球最常见的慢性肝病。它代表了一系列疾病，从单纯性肝脂肪变性到脂肪性肝炎，后者可能发展为进行性肝纤维化甚至肝硬化。NAFLD是成人肝移植中增长最迅速的适应证。在儿童中，NAFLD的发病率在过去十年中也有所上升。虽然大多数患有NAFLD的儿童超重或肥胖，但体重指数正常的儿童中出现所谓的瘦型NAFLD的比例也在增加。儿童NAFLD与多种肝外表现相关，包括高脂血症、胰岛素抵抗和阻塞性睡眠呼吸暂停。儿童NAFLD的发病机制涉及遗传、宫内暴露、幼儿期暴露和持续的营养暴露之间的多因素相互作用。虽然儿童NAFLD和成人NAFLD之间存在一些相似之处，但儿童的肝活检显示两者在组织学上存在差异。目前儿童NAFLD的标准治疗方法是改变生活方式，减少热量摄入并增加身体活动。目前尚无获批用于治疗儿童NAFLD的药物。本文旨在总结目前对儿童NAFLD的认识以及未来干预和治疗目标的方向。
