Children ages 9-11 years with obesity should be screened for non-alcoholic fatty liver disease (NAFLD), according to new guidelines endorsed by the Academy.
The clinical practice guideline from an expert panel of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) includes 27 recommendations that cover screening, diagnosis, treatment and long-term care of children with NAFLD.
NAFLD impacts as many as 38% of children with obesity, though not all who have the chronic disease are obese.
“It has rapidly evolved into the most common liver disease seen in the pediatric population and is a management challenge for general pediatric practitioners, subspecialists and for health systems,” authors said in the report “NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children” (Vos MB, et al. J Pediatr Gastroenterol Nutr. Dec. 1, 2016, http://bit.ly/2gNvWFY).
Citing a gap in available guidance, the NASPGHAN convened a panel of experts who reviewed literature and made recommendations they say “suggest preferred evidence-based approaches … but remain flexible and adjustable for individual patients and circumstances.”
Children with NAFLD often are asymptomatic. The panel recommends screening children age 9-11 years with obesity and other children with risk factors using an alanine aminotransferase test.
“Screening for NAFLD is appropriate because it can be detected prior to the onset of irreversible, end-stage liver disease,” authors wrote. “Identification of children with NAFLD is important because effective treatment is available.”
Children will need to undergo additional tests, which may include a biopsy, to determine if fat deposits are present and rule out other conditions.
For those diagnosed with NAFLD, treatment includes improving their diet, avoiding sugar-sweetened beverages and increasing physical activity.
“No currently available medications or supplements are recommended to treat NAFLD
because none have been proven to benefit the majority of NAFLD patients,” according to the guidelines.
Only certain adolescents with severe health issues should be considered for bariatric surgery.
The panel also recommends periodic screening for dyslipidemia and diabetes, vaccination against hepatitis and monitoring children annually for disease progression. They also should be counseled about the dangers of binge drinking and smoking.
