Problemi correnti
Il “fegato grasso” del bambino: malattia o disturbo
cosmetico?
FATTY LIVER” IN CHILDREN: LIVER DISEASE OR COSMETIC ABNORMALITY?
GIUSEPPE MAGGIORE, MARCO SCIVERES
Dipartimento di Medicina della Procreazione e della Etŕ Evolutiva, Azienda Ospedaliera Universitaria Pisana
Febbraio 2007 - pagg. 105 -110
Abstract
Fatty liver disease (FLD) is the term used to describe a spectrum of liver disorders characterized
by macrovesicular steatosis. In adults and adolescents alcohol consumption in amounts
considered to be harmful to the liver must be excluded. Because of the likehood of having FLD
is directly proportional to body mass index, given the increasing prevalence of obesity, nonalcoholic
FLD (NAFLD) is an important public health problem. There are two recognized histologic
pattern of NAFLD: fatty liver alone and steatohepatitis (NASH). The latter represents
a shift from simple steatosis to an inflammatory component. NASH is described by grading
that indicates the activity of the inflammatory lesion and by staging that reflects the progressive
degree of fibrosis. The presence of fat in the liver can be suggested by various imaging
modalities, however no current non invasive methods can distinguish NASH from NAFLD. Liver
biopsy remains the gold standard for staging and grading. The presence, degree and pattern
of aminotransferase elevation are non specific and do not distinguish between fatty liver
alone and NASH. Prevalence of FLD in unselected children is about 10% and it increases with
age; in selected population such as obese children it reaches about 50% al cases. Obesity and
insulin resistance are key factors in exacerbating hepatic inflammation and fibrogenesis.
There is no effective treatment of NAFLD, but there are several approach to this problem including
weight reduction by diet and exercise, pharmacologic treatment of insulin resistance
and use of drugs such as antioxidant (α-tocopherol) or insulin sensitizer such as metformin
Parole chiave
Classificazione MeSH
Bibliografia
1. Patton HM, Sirlin C, Behling C, Middleton
M, Schwimmer JB, Lavine JE. Pediatric nonalcoholic
fatty liver disease: a critical appraisal of
current data and implications for future research.
J Pediatr Gastroenterol Nutr 2006;43:
413-27.
2. Marion AW, Baker AJ, Dhawan A. Fatty liver disease in children. Arch Dis Child 2004;89: 648-52.
3. Adams LA, Feldstein A, Lindor K, Angulo P. Non alcoholic fatty liver disease among patients with hypothalamic and pituitary dysfunction. Hepatology 2004;39: 909-14.
4. Franzese A, Vajro P, Argenziano A, et al. Liver involvement in obese children. Ultrasonography and liver enzyme levels at diagnosing and during follow-up in an Italian population. Dig Dis Sci 1997;42:1438-42.
5. Chan DF, Li AM, Chu WC, et al. Hepatic steatosis in obese Chinese children. Int J Obes Relat Metabol Disord 2004;28:12.
6. Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of fatty liver in children and adolescents. Pediatrics 2006;118:1388-92.
7. Schwimmer JB, Deutsch R, Rauch JB, Behling C, Newbury R, Lavine JE. Obesity, insulin resistence, and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease. J Pediatr 2003;143:500-5.
8. Nobili V, Pastore A, Gaeta ML, et al. Glutathione metabolism and antioxidant enzymes in patients affected by nonalcoholic steatohepatitis. Clin Chim Acta 2005;355:105-11.
9. Kleiner DE, Brunt E M, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41:1313-21.
10. Schwimmer JB, Behling C, Newbury R, et al. Histopathology of paediatric non alcoholic fatty liver disease. Hepatology 2005;42:641-9.
11. Ryan Riley M, Bass NM, Rosenthal P, Merriman RB. Underdiagnosis of pediatric obesity and underscreening for fatty liver disease and metabolic syndrome by pediatrician and pediatric subspecialists. J Pediatr 2005;147:839-42.
12. Vajro P, Fontanella A, Perna C, Orso G, Tedesco M, De Vincenzo A. Persistent hypertransaminasemia resolving after weight reduction in obese children. J Pediatr 1994;125: 239- 41.
13. Nobili V, Marcellini M, Devito R, et al. NAFLD in children: a prospective clinic-pathological study and effect of lifestyle advice. Hepatology 2006;44:458-65.
14. Schwimmer JB, Middleton MS, Deutsch R, Lavine JE. A phase 2 clinical trial of metformin as a treatment for non diabetic paediatric non alcoholic steatohepatitis. Alim Pharmacol Ther 2005;21:871-9.
2. Marion AW, Baker AJ, Dhawan A. Fatty liver disease in children. Arch Dis Child 2004;89: 648-52.
3. Adams LA, Feldstein A, Lindor K, Angulo P. Non alcoholic fatty liver disease among patients with hypothalamic and pituitary dysfunction. Hepatology 2004;39: 909-14.
4. Franzese A, Vajro P, Argenziano A, et al. Liver involvement in obese children. Ultrasonography and liver enzyme levels at diagnosing and during follow-up in an Italian population. Dig Dis Sci 1997;42:1438-42.
5. Chan DF, Li AM, Chu WC, et al. Hepatic steatosis in obese Chinese children. Int J Obes Relat Metabol Disord 2004;28:12.
6. Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of fatty liver in children and adolescents. Pediatrics 2006;118:1388-92.
7. Schwimmer JB, Deutsch R, Rauch JB, Behling C, Newbury R, Lavine JE. Obesity, insulin resistence, and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease. J Pediatr 2003;143:500-5.
8. Nobili V, Pastore A, Gaeta ML, et al. Glutathione metabolism and antioxidant enzymes in patients affected by nonalcoholic steatohepatitis. Clin Chim Acta 2005;355:105-11.
9. Kleiner DE, Brunt E M, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41:1313-21.
10. Schwimmer JB, Behling C, Newbury R, et al. Histopathology of paediatric non alcoholic fatty liver disease. Hepatology 2005;42:641-9.
11. Ryan Riley M, Bass NM, Rosenthal P, Merriman RB. Underdiagnosis of pediatric obesity and underscreening for fatty liver disease and metabolic syndrome by pediatrician and pediatric subspecialists. J Pediatr 2005;147:839-42.
12. Vajro P, Fontanella A, Perna C, Orso G, Tedesco M, De Vincenzo A. Persistent hypertransaminasemia resolving after weight reduction in obese children. J Pediatr 1994;125: 239- 41.
13. Nobili V, Marcellini M, Devito R, et al. NAFLD in children: a prospective clinic-pathological study and effect of lifestyle advice. Hepatology 2006;44:458-65.
14. Schwimmer JB, Middleton MS, Deutsch R, Lavine JE. A phase 2 clinical trial of metformin as a treatment for non diabetic paediatric non alcoholic steatohepatitis. Alim Pharmacol Ther 2005;21:871-9.
Corrispondenza: g.maggiore@clp.med.unipi.it