Pediatric NAFLD: an overview and recent developments in diagnostics and treatment

<b>Introduction</b>: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children and adults in industrialized countries. Besides liver-related morbidity, NAFLD is also associated with an increased risk of cardiovascular disease, type 2 diabetes and mortality at adult age. However, despite the high prevalence and serious complications, diagnosing and staging of disease remains complicated due to a lack of accurate screening tools and non-invasive methods to detect fibrosis. <b>Areas covered</b>: Recent insights in epidemiology, pathogenesis, diagnostic evaluation and treatment options in pediatric NAFLD are being reviewed, with a particular focus on new developments in diagnostic tools. <b>Expert opinion</b>: Due to their long life span, children with NAFLD are particularly at risk of complications in their lifetime. Therefore, an effective screening strategy for children to identify those with NAFLD at risk of complications is urgently needed. This is further underscored by new pharmacological therapies that are expected to become available in the next 5 years. Momentarily no accurate non-invasive method for diagnosing pediatric NAFLD is available. New promising biomarkers and imaging tools could hopefully provide better screening tools and could contribute to the development of a successful management plan to identify children with NAFLD.

<b>引言</b>: 非酒精性脂肪性肝病（Non-alcoholic fatty liver disease, NAFLD）是工业化国家中儿童与成人最常见的慢性肝脏疾病。除引发肝脏相关的疾病负担外，非酒精性脂肪性肝病还与心血管疾病、2型糖尿病的患病风险升高及成年后死亡风险增加存在显著关联。尽管该病患病率较高且可引发严重并发症，但由于缺乏精准的筛查工具与无创性纤维化检测手段，其诊断与分期仍存在较大难度。<b>综述涵盖内容</b>: 本综述系统梳理了儿童非酒精性脂肪性肝病在流行病学、发病机制、诊断评估及治疗方案方面的最新研究进展，重点聚焦于诊断工具的全新发展。<b>专家观点</b>: 由于患儿整体预期寿命较长，儿童非酒精性脂肪性肝病患者在其一生中出现并发症的风险尤为显著。因此，亟需建立针对儿童群体的有效筛查策略，以识别出存在并发症风险的非酒精性脂肪性肝病患儿。未来5年内有望投入临床使用的新型药物治疗方案，进一步凸显了建立此类筛查策略的紧迫性。目前尚无用于诊断儿童非酒精性脂肪性肝病的精准无创检测方法。颇具应用前景的新型生物标志物与影像学工具，有望提供更为优质的筛查手段，助力制定科学有效的管理方案，以精准识别儿童非酒精性脂肪性肝病患者。