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The aim of this review is to summarize what is known about pediatric non-alcoholic fatty liver disease (NAFLD) in terms of prevalence, pathogenesis, diagnosis, histology and treatment. NAFLD is increasingly recognized as a major health burden in obese children. NAFLD is a spectrum, ranging from fatty infiltration of the liver alone (steatosis), which may lead to fatty infiltration with inflammation known as steatohepatitis or non alcoholic steatohepatitis (NASH) that is characterized by the potential to progress to fibrosis, cirrhosis and end stage liver disease. NASH is associated with obesity, diabetes, insulin resistance and hypertriglyceridemia. While the majority of individuals with risk factors like obesity and insulin resistance (IR) have steatosis, only a minority develop steatohepatitis. Although steatosis is a prerequisite for the definition of NAFLD in adults and children, distinct differences are often apparent in the extent or location of fat, inflammation and fibrosis. Confirmation of the diagnosis of NAFLD can usually be achieved by imaging studies; however, staging the disease requires a liver biopsy. Current treatment relies on weight loss and exercise, although various insulin-sensitizing medications appear promising.