Skip to main content
SpringerLink
Log in

Nonalcoholic fatty liver disease (NAFLD): Approach in the adolescent patient

  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a spectrum of liver disease whose hallmark is the accumulation of large-droplet fat in hepatocytes. This metabolic disorder occurs mainly in overweight or obese individuals. The disease mechanism involves hyperinsulinemia and hepatic insulin resistance, not ethanol abuse. NAFLD may be the hepatic manifestation of the “metabolic syndrome” classically associated with type 2 diabetes mellitus and cardiovascular disease. NAFLD ranges from simple steatosis, which is the least rapidly progressing disorder, to nonalcoholic steatohepatitis to cirrhosis, which can evolve to chronic liver failure. The high prevalence of NAFLD in children has been recognized only in the past 5 to 10 years, as rates of childhood obesity have soared. Accordingly, the best strategies for diagnosis and treatment of childhood NAFLD are a work in progress and remain controversial. Weight reduction through a healthy diet and regular medium-intensity exercise is the mainstay of current treatment. Few research data are available to guide pharmacologic therapy. Certain points regarding management of childhood NAFLD require emphasis: It is a serious liver disease that requires detailed clinical investigation. Other liver diseases causing fatty Liver and/or abnormal liver tests, notably Wilson disease and chronic viral hepatitis, need to be excluded. Liver biopsy can provide critical diagnostic and staging information. Associated genetic or endocrine disorders need to be identified. Treatment should begin with a low-glycemic index diet that provides adequate nutrients but is low in harmful fats and eliminates foods causing postprandial hyperglycemia. Initially, this can target two to three problem foods so that it is easy for the adolescent to follow. Regular exercise suited to the capabilities and interests of the teenager should be added to the daily routine. Where possible, a team approach, including a dietician and psychologist, should be utilized, as adolescents do better in a supportive atmosphere. Optimal drug treatment requires further research: current front-runners are vitamin E and metformin. The roles of drugs that alter appetite and bariatric surgery for adolescents with NAFLD have not been determined.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Schwimmer JB, Behling C, Newbury R, et al.:Histopathology of pediatric nonalcoholic fatty liver disease.Hepatology 2005,42:641–649.

    Article  PubMed  Google Scholar 

  2. Setji TL, Holland ND, Sanders LL, et al.:Nonalcoholic steatohepatitis and nonalcoholic fatty liver disease in young women with polycystic ovary syndrome.J Clin Endocrinol Metab 2006,91:1741–1747.

    Article  PubMed  CAS  Google Scholar 

  3. Riley MR, Bass NM, Rosenthal P, Merriman RB:Underdiagnosis of pediatrie obesity and underscreening for fatty liver disease and metabolic syndrome by pediatricians and pediatrie subspecialists.J Pediatr 2005,147:839–842.

    Article  PubMed  Google Scholar 

  4. Harrison SA:New treatments for nonalcoholic fatty liver disease.Curr Gastroenterol Rep 2006,8:21–29.

    Article  PubMed  Google Scholar 

  5. Vajro P, Fontanella A, Perna C, et al.:Persistent hypertransaminasemia resolving after weight reduction in obese children.J Pediatr 1994,125:239–241.

    Article  PubMed  CAS  Google Scholar 

  6. Vajro P, Franzese A, Valerio G, et al.:Lack of efficacy of ursodeoxycholic acid for the treatment of liver abnormalities in obese children.J Pediatr 2000,136:739–743.

    Article  PubMed  CAS  Google Scholar 

  7. Rashid M, Roberts EA:Nonalcoholic steatohepatitis in children.J Pediatr Gastroenterol Nutr 2000,30:48–53.

    Article  PubMed  CAS  Google Scholar 

  8. Ebbeling CB, Leidig MM, Sinclair KB, et al.:A reducedglycemic load diet in the treatment of adolescent obesity.Arch Pediatr Adolesc Med 2003,157:773–779.

    Article  PubMed  Google Scholar 

  9. Golan M, Kaufman V, Shahar DR:Childhood obesity treatment: targeting parents exclusively v. parents and children.Br J Nutr 2006,95:1008–1015.

    Article  PubMed  CAS  Google Scholar 

  10. Lavine JE:Vitamin E treatment of nonalcoholic steatohepatitis in children: a pilot study.J Pediatr 2000,136:734–738.

    Article  PubMed  CAS  Google Scholar 

  11. Vajro P, Mandato C, Franzese A, et al.:Vitamin E treatment in pediatrie obesity-related liver disease: a randomized study.J Pediatr Gastroenterol Nutr 2004,38:48–55.

    Article  PubMed  CAS  Google Scholar 

  12. Harrison SA, Torgerson S, Hayashi P, et al.:Vitamin E and vitamin C treatment improves fibrosis in patients with nonalcoholic steatohepatitis.Am J Gastroenterol 2003,98:2485–2490.

    Article  PubMed  CAS  Google Scholar 

  13. Kugelmas M, Hill DB, Vivian B, et al.:Cytokines and NASH: a pilot study of the effects of lifestyle modification and vitamin E.Hepatology 2003,38:413–419.

    Article  PubMed  CAS  Google Scholar 

  14. Mendez-Sanchez N, Gonzalez V, Chavez-Tapia N, et al.:Weight reduction and ursodeoxycholic acid in subjects with nonalcoholic fatty liver disease. A doubleblind, placebo-controlled trial.Ann Hepatol 2004,3:108–112.

    PubMed  Google Scholar 

  15. Lindor KD, Kowdley KV, Heathcote EJ, et al:Ursodeoxycholic acid for treatment of nonalcoholic steatohepatitis: results of a randomized trial.Hepatology 2004,39:770–778.

    Article  PubMed  CAS  Google Scholar 

  16. 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.Aliment Pharmacol Ther 2005,21:871–879.

    Article  PubMed  CAS  Google Scholar 

  17. Marchesini G, Brizi M, Bianchi G, et al.:Metformin in non-alcoholic steatohepatitis.Lancet 2001,358:893–894.

    Article  PubMed  CAS  Google Scholar 

  18. Uygun A, Kadayifci A, Isik AT, et al.:Metformin in the treatment of patients with non-alcoholic steatohepatitis.Aliment Pharmacol Ther 2004,19:537–544.

    Article  PubMed  CAS  Google Scholar 

  19. Nair S, Diehl AM, Wiseman M, et al.:Metformin in the treatment of non-alcoholic steatohepatitis: a pilot open label trial.Aliment Pharmacol Ther 2004,20:23–28.

    Article  PubMed  CAS  Google Scholar 

  20. Bugianesi E, Gentilcore E, Manini R, et al.:A randomized controlled trial of metformin versus vitamin E or prescriptive diet in nonalcoholic fatty liver disease.Am J Gastroenterol 2005,100:1082–1090.

    Article  PubMed  CAS  Google Scholar 

  21. Kay JP, Alemzadeh R, Langley G, et al.:Beneficial effects of metformin in normoglycemic morbidly obese adolescents.Metabolism 2001,50:1457–1461.

    Article  PubMed  CAS  Google Scholar 

  22. Arslanian SA, Lewy V, Danadian K, Saad R:Metformin therapy in obese adolescents with polycystic ovary syndrome and impaired glucose tolerance: amelioration of exaggerated adrenal response to adrenocorticotropin with reduction of insulinemia/insulin resistance.J Clin Endocrinol Metab 2002,87:1555–1559.

    Article  PubMed  CAS  Google Scholar 

  23. Harrison SA, Fincke C, Helinski D, et al:A pilot study of orlistat treatment in obese, non-alcoholic steatohepatitis patients.Aliment Pharmacol Ther 2004,20:623–628.

    Article  PubMed  CAS  Google Scholar 

  24. Zelber-Sagi S, Kessler A, Brazowsky E, et al.:A double-blind randomized placebo-controlled trial of orlistat for the treatment of nonalcoholic fatty liver disease.Clin Gastroenterol Hepatol 2006,4:639–644.

    Article  PubMed  CAS  Google Scholar 

  25. Chanoine JP, Hampl S, Jensen C, et al.:Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial.JAMA 2005,293:2873–2883.

    Article  PubMed  CAS  Google Scholar 

  26. Berkowitz RI, Wadden TA, Tershakovec AM, Cronquist JL:Behavior therapy and sibutramine for the treatment of adolescent obesity: a randomized controlled trial.JAMA 2003,289:1805–1812.

    Article  PubMed  CAS  Google Scholar 

  27. James WP, Astxup A, Finer N, et al.:Effect of sibutramine on weight maintenance after weight loss: a randomised trial. STORM Study Group. Sibutramine Trial of Obesity Reduction and Maintenance.Lancet 2000,356:2119–2125.

    Article  PubMed  CAS  Google Scholar 

  28. Wadden TA, Berkowitz RI, Womble LG, et al.:Randomized trial of lifestyle modification and pharmacotherapy for obesity.N Engl J Med 2005,353:2111–2120.

    Article  PubMed  CAS  Google Scholar 

  29. Ioannides-Demos LL, Proietto J, Tonkin AM, McNeil JJ:Safety of drug therapies used for weight loss and treatment of obesity.Drug Saf 2006,29:277–302.

    Article  PubMed  CAS  Google Scholar 

  30. Miglio F, Rovati LC, Santoro A, Setnikar I:Efficacy and safety of oral betaine glucuronate in non-alcoholic steatohepatitis. A double-blind, randomized, parallel-group, placebo-controlled prospective clinical study.Arzneimittelforschung 2000,50:722–727.

    PubMed  CAS  Google Scholar 

  31. Neuschwander-Tetri BA, Brunt EM, Wehmeier KR, et al.:Improved nonalcoholic steatohepatitis after 48 weeks of treatment with the PPAR-gamma ligand rosiglitazone.Hepatology 2003,38:1008–1017.

    PubMed  CAS  Google Scholar 

  32. Promrat K, Lutchman G, Uwaifo GI, et al:A pilot study of pioglitazone treatment for nonalcoholic steatohepatitis.Hepatology 2004,39:188–196.

    Article  PubMed  CAS  Google Scholar 

  33. Sanyal AJ, Mofrad PS, Contos MJ, et al.:A pilot study of vitamin E versus vitamin E and pioglitazone for the treatment of nonalcoholic steatohepatitis.Clin Gastroenterol Hepatol 2004,2:1107–1115.

    Article  PubMed  CAS  Google Scholar 

  34. Adams LA, Zein CO, Angulo P, Lindor KD:A pilot trial of pentoxifylline in nonalcoholic steatohepatitis.Am J Gastroenterol 2004,99:2365–2368.

    Article  PubMed  CAS  Google Scholar 

  35. Satapathy SK, Garg S, Chauhan R, et al:Beneficial effects of tumor necrosis factor-alpha inhibition by pentoxifylline on clinical, biochemical, and metabolic parameters of patients with nonalcoholic steatohepatitis.Am Gastroenterol 2004,99:1946–1952.

    Article  CAS  Google Scholar 

  36. Yokohama S, Yoneda M, Haneda M, et al.:Therapeutic efficacy of an angiotensin II receptor antagonist in patients with nonalcoholic steatohepatitis.Hepatology 2004,40:1222–1225.

    Article  PubMed  CAS  Google Scholar 

  37. Dixon JB, Bhathal PS, Hughes NR, O’Brien PE:Nonalcoholic fatty liver disease: improvement in liver histological analysis with weight loss.Hepatology 2004,39:1647–1654.

    Article  PubMed  Google Scholar 

  38. Inge TH, Krebs NF, Garcia VF, et al:Bariatric surgery for severely overweight adolescents: concerns and recommendations.Pediatrics 2004,114:217–223.

    Article  PubMed  Google Scholar 

  39. Lawson ML, Kirk S, Mitchell T, et al.:One-year outcomes of Roux-en-Y gastric bypass for morbidly obese adolescents: a multicenter study from the Pediatric Bariatric Study Group.J Pediatr Surg 2006,41:137–143.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Room 8267, Black Wing, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, Ontario, Canada

    Eve A. Roberts MD, FRCP(C)

Authors
  1. Eve A. Roberts MD, FRCP(C)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jason Yap MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eve A. Roberts MD, FRCP(C).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roberts, E.A., Yap, J. Nonalcoholic fatty liver disease (NAFLD): Approach in the adolescent patient. Curr Treat Options Gastro 9, 423–431 (2006). https://doi.org/10.1007/BF02738532

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02738532

Keywords

Search

Navigation