Is the clinical impact of nonalcoholic fatty liver disease (NAFLD) the Y2K of our specialty? Have we fashioned a mountain from a molehill of end-stage liver disease? The answer merits some consideration. Ian Wanless’s landmark cross-sectional study reported convincingly that the overall prevalence of NASH in adults in North America is 18.5% in obese and 2.7% in nonobese individuals.1 Of obese individuals found to have NASH at autopsy, about one in seven had bridging fibrosis or cirrhosis.… Continue

Most patients with a BMI of 30 or greater, and many with a BMI between 25 and 30, have at least… Continue

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TREATMENT OF NASH IN THE PEDIATRIC POPULATION No drug therapies have been developed specifically for the treatment of fatty liver disease in either children or adults. The strategies that have been used in the treatment of NASH thus far are based on the current best understanding of the pathophysiology of this disease, the so-called "2-hit theory" (66). Thus, weight loss/decreased visceral fat, improved insulin sensitivity and antioxidant therapy have been the approaches explored in ther… Continue

Clinical series have reported fibrosis in 53% to 100% of liver biopsies from children with NAFLD, including several reports of children with cirrhosis (4,9-11). In fact, cirrhosis secondary to NASH has been reported in children as young as 10 years (10). A recent case report described a young man dying of complications of liver failure secondary to NASH cirrhosis at the age of 34 years (110). The incidence rate of cirrhosis secondary to pediatric NASH is unknown at this time. Predictors of advan… Continue