Nonalcoholic Fatty Liver Disease Flashcards
Nonalcoholic fatty liver disease (NAFLD) triad. …..?
NAFLD can range from fatty liver alone to a triad of fatty infiltration, inflammation, and fibrosis termed nonalcoholic steatohepatitis (NASH)
Type 1 NASH resembles ….?
Resembles adult histologic findings with steatosis and balloon degeneration of hepatocytes and/or periportal fibrosis
Type 2 NASH includes ….?
Steatosis and portal inflammation.
Is aminotransferase sensitive in NAFLD ….?
No
A normal serum ALT level is present in 21–23% of pediatric patients with NAFLD
Gold standard for diagnosis of NAFLD ….?
A liver biopsy may be required for a delimiting diagnosis. There are no reliable biomarkers available to serve as an alternative to liver biopsy.
Risk factors for NAFLD ….?
obesity, male gender, white or Hispanic ethnicity, hypertriglyceridemia, and insulin resistance
Obese and overweight children with other risk factors should be screened for NAFLD at what age …….?
> 3 yr of age should be screened for NAFLD by checking aminotransferase levels and liver ultrasound, even though neither is highly sensitive or specific.
What is Lysosomal acid lipase deficiency (LAL-D), ?
Autosomal recessive disorder due to mutations in LIPA may produce a hepatic steatosis like syndrome
In contrast to NAFLD, patients with LAL-D usually demonstrate microvesicular or mixed micro- and macrovesicular steatosis not macrovesicular changes
Proven therapeutic trials in NAFLD ….?
Gradual weight loss
Low glycemic index foods and substituting polyunsaturated fatty acids for saturated fats may help
Vitamin E and vitamin C provide no additional benefit to the efficacy of lifestyle intervention (diet and exercise) in improving steatosis or biochemical abnormalities in pediatric NAFLD
Role of vitamin E in NASH …..?
vitamin E has been shown to improve balloon degeneration in children with NASH.
Role of metformin in NASH …..?
Metformin has produced mixed results in the treatment of NAFLD.
Thiazolidinediones (pioglitazone, rosiglitazone) improve liver histology in adults with NASH but have not been studied in children
Role of probiotics in NASH …..?
In view of the potential role of the gut microbiome in contributing to the pathogenesis of NAFLD, the role of probiotics as an adjunct to lifestyle changes is under investigation.
What is Cysteamine bitartrate ?..
Cysteamine bitartrate (slow release), a potential precursor of glutathione, an antioxidant, may reduce liver enzyme levels, as well as serum leptin and adiponectin levels, and is also a potential candidate for the treatment of NAFLD
What is the role of Incretin in NAFLD ?
GLP-1 is a neuropeptide (incretin) that has an antihyperglycemic effect. A metaanalysis demonstrated decreased ALT and improved imaging findings, as well as histologic features in adults with NAFLD and diabetes treated with GLP-1 agonists
