NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children: Recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) - PubMed (original) (raw)

Practice Guideline

NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children: Recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN)

Miriam B Vos et al. J Pediatr Gastroenterol Nutr. 2017 Feb.

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent chronic liver disease that occurs in the setting of insulin resistance and increased adiposity. 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. In this guideline, the expert committee on NAFLD reviewed and summarized the available literature, formulating recommendations to guide screening and clinical care of children with NAFLD.

PubMed Disclaimer

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST / FINANCIAL DISCLOSURE STATEMENT

MV has research funding from Resonance Health Inc, serves on a DSMB for Aegerion and as a consultant for Shire, Immuron, Intercept and Target Pharmasolutions. SD serves on a DMC for Novo Nordisk and consults for Sanofi. RK has research funding from Raptor. The remaining authors have no personal or financial conflicts of interest to declare.

Figures

Figure 1

Figure 1

An algorithm proposed by the ECON group. Further research is likely to alter the algorithm. The steps are suggested courses of action and should be interpreted within the clinical scenario of individual patients. Additional testing

for chronic liver diseases to consider:

  1. Screening labs: CBC with differential, AST, bilirubin (total, conjugated), alkaline phosphatase, GGT, INR, albumin, total protein, hemoglobin A1c
  2. Exclude infections (e.g. hepatitis A IgM, hepatitis B surface antigen, hepatitis C antibody, other chronic viral infections)
  3. Exclude endocrine disorders (TSH, free T4)
  4. Exclude autoimmune causes of ALT elevation (total IgA, total IgG and tissue transglutaminase antibody, anti-nuclear antibody, anti-smooth muscle antibody, anti-liver kidney microsomal antibody)
  5. Exclude genetic causes of ALT (ceruloplasmin and/or 24 hour urine copper, lysosomal acid lipase, alpha-1 antitrypsin phenotype)
  6. Imaging: Abdominal ultrasound to rule out anatomical abnormalities or assess features of portal hypertension, magnetic resonance imaging or spectroscopy to measure hepatic fat.
  7. Liver biopsy (histology, copper measurement, stain for microvesicular fat, assess fibrosis)

Red flags

for advanced liver disease

– chronic fatigue, GI bleeding, jaundice, splenomegaly, firm liver on exam, enlarged left lobe of the liver, low platelets, low white blood cell count, elevated direct bilirubin, elevated international normalized ratio (INR), long history of elevated liver enzymes (> 2 years).

Figure 2

Figure 2

Treatments for pediatric NAFLD

Comment in

Similar articles

Cited by

References

    1. Wong RJ, Aguilar M, Cheung R, Perumpail RB, Harrison SA, Younossi ZM, et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148(3):547–55. - PubMed
    1. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55(6):2005–23. - PubMed
    1. Vajro P, Lenta S, Socha P, Dhawan A, McKiernan P, Baumann U, et al. Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr. 2012;54(5):700–13. - PubMed
    1. Louthan MV, Theriot JA, Zimmerman E, Stutts JT, McClain CJ. Decreased prevalence of nonalcoholic fatty liver disease in black obese children. Journal of pediatric gastroenterology and nutrition. 2005;41(4):426–9. - PubMed
    1. Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of fatty liver in children and adolescents. Pediatrics. 2006;118(4):1388–93. - PubMed

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources