Hathagoda Wathsala, Rajindrajith Shaman, Niriella Madunil Anuk
Department of Paediatrics, Faculty of Medicine, University of Colombo, Kynsey Road Colombo 8, Colombo, 00800, Sri Lanka.
University Paediatric Unit, Lady Ridgeway Hospital for Children, Danister de Silva Road, Colombo 08, Colombo, 00800, Sri Lanka.
World J Pediatr. 2025 Apr;21(4):352-360. doi: 10.1007/s12519-025-00902-w. Epub 2025 Apr 19.
Given the rising prevalence of pediatric steatotic liver disease (SLD), it is imperative to identify and address common challenges in clinical practice. This article aims to examine key issues in managing pediatric SLD and attempts to propose evidence-based recommendations.
We reviewed published literature on steatotic liver diseases in children focusing on overweight and obesity, including original research, systematic reviews, meta-analyses, consensus statements, and position papers. Databases searched were PubMed/MEDLINE, Cochrane Library, Web of Science, and Scopus. Search terms included: "non-alcoholic fatty liver disease", "NAFLD", "steatohepatitis", "NASH", "steatotic liver disease", "fatty liver", "children", "adolescents", "pediatric", "obesity", and "overweight".
Critical issues include an over-reliance on liver biochemistry, which may fail to capture the broader spectrum of SLD [e.g., metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction associated with steatohepatitis (MASH)], and delays in recognizing metabolic comorbidities. Dietary and lifestyle recommendations are often generalized, overlooking individual patient needs, while psychological factors, such as stress and mental health, are frequently neglected despite their role in disease progression. Advanced fibrosis cases are under-referred, long-term risks like cirrhosis are underestimated, and insufficient follow-up, coupled with limited family involvement in education, further compromises care.
Addressing these deficiencies through a multidisciplinary approach that incorporates early diagnosis, personalized treatment strategies, structured monitoring, and comprehensive family involvement is imperative for optimizing outcomes and mitigating the long-term impact of pediatric SLD.
鉴于儿童脂肪性肝病（SLD）的患病率不断上升，识别并应对临床实践中的常见挑战至关重要。本文旨在探讨儿童SLD管理中的关键问题，并尝试提出基于证据的建议。
我们回顾了已发表的关于儿童脂肪性肝病的文献，重点关注超重和肥胖，包括原始研究、系统评价、荟萃分析、共识声明和立场文件。检索的数据库有PubMed/MEDLINE、Cochrane图书馆、科学网和Scopus。检索词包括：“非酒精性脂肪性肝病”、“NAFLD”、“脂肪性肝炎”、“NASH”、“脂肪性肝病”、“脂肪肝”、“儿童”、“青少年”、“儿科”、“肥胖”和“超重”。
关键问题包括过度依赖肝脏生化指标，这可能无法全面反映SLD的范围[例如，代谢功能障碍相关脂肪性肝病（MASLD）和与脂肪性肝炎相关的代谢功能障碍（MASH）]，以及代谢合并症识别延迟。饮食和生活方式建议往往过于笼统，忽视了个体患者的需求，而心理因素，如压力和心理健康，尽管在疾病进展中起作用，但却常常被忽视。晚期纤维化病例转诊不足，肝硬化等长期风险被低估，随访不足，加上家庭在教育方面的参与有限，进一步影响了治疗效果。
通过多学科方法解决这些不足，包括早期诊断、个性化治疗策略、结构化监测和全面的家庭参与，对于优化治疗效果和减轻儿童SLD的长期影响至关重要。
