From the Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK.
J Pediatr Gastroenterol Nutr. 2023 Nov 1;77(5):583-591. doi: 10.1097/MPG.0000000000003919. Epub 2023 Aug 18.
The obesity epidemic is one of the major health concerns of the 21st century. Nonalcoholic fatty liver disease (NAFLD) is linked with the increased adiposity associated with obesity. NAFLD has become the most frequent cause of chronic liver disease in adults and children worldwide. Metabolic dysfunction-associated fatty liver disease (MAFLD) also known in children as pediatric fatty liver disease (PeFLD) type 2 has begun to supersede NAFLD as the preferred nomenclature in the pediatric population. Evidence suggests the etiology of MAFLD is multifactorial, related to the complex interplay of hormonal, nutritional, genetic, and environmental factors. Current limitations in accurate diagnostic biomarkers have rendered it a diagnosis of exclusion and it is important to exclude alternative or coexisting causes of PeFLD. Lifestyle changes and modifications remains the primary treatment modality in MAFLD in children. Weight loss of 7%-10% is described as reversing MAFLD in most patients. The Mediterranean diet also shows promise in reversing MAFLD. Pharmacological intervention is debatable in children, and though pediatric trials have not shown promise, other agents undergoing adult clinical trials show promise. This review outlines the latest evidence in pediatric MAFLD and its management.
肥胖症是 21 世纪主要健康问题之一。非酒精性脂肪性肝病（NAFLD）与肥胖相关的脂肪堆积有关。NAFLD 已成为全世界成年人和儿童慢性肝病的最常见原因。代谢相关脂肪性肝病（MAFLD）在儿童中也称为 2 型小儿脂肪肝（PeFLD），已开始取代 NAFLD，成为儿科人群中的首选命名法。有证据表明，MAFLD 的病因是多因素的，与激素、营养、遗传和环境因素的复杂相互作用有关。目前准确诊断生物标志物的局限性使其成为一种排除性诊断，排除小儿脂肪肝的其他或共存原因很重要。生活方式的改变和调整仍然是儿童 MAFLD 的主要治疗方式。体重减轻 7%-10%被描述为大多数患者 MAFLD 的逆转。地中海饮食在逆转 MAFLD 方面也显示出希望。药物干预在儿童中存在争议，尽管儿科试验没有显示出希望，但其他正在进行成人临床试验的药物显示出希望。这篇综述概述了儿科 MAFLD 及其治疗的最新证据。
