Nonalcoholic fatty liver disease (NAFLD) is a generic term encompassing a spectrum of disorders defined by their histopathology. On one end of the continuum is simple macrovesicular steatosis, which is defined by large fat droplets within hepatocytes. Over time, however, simple steatosis may progress. When inflammation is present, with or without fibrosis, the condition is known as nonalcoholic steatohepatitis (NASH). The far end of the spectrum is frank cirrhosis. All of the entities constituting NAFLD are associated with obesity and insulin resistance and, by definition, occur in the absence of alcohol consumption.

First described in the pediatric literature just over 25 years ago, NAFLD today is recognized as an increasingly significant cause of liver disease. Estimates of the overall prevalence of NAFLD vary, based on the method of detection, but it likely is present in approximately 9% of all children and in up to 80% of obese children. With the...

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