Paralleling the growing prevalence of obesity and metabolic syndrome, nonalcoholic fatty liver disease (NAFLD) is emerging as the most frequent hepatopathy in adults and children. The true prevalence of pediatric NAFLD is still unknown, because of the heterogeneity of diagnostic methods used for diagnosis in the available studies and the different characteristics of the populations evaluated. Pediatric NAFLD is typically of primary origin and it is strongly associated with several features of the metabolic syndrome. Age, gender and race/ethnicity are significant determinants of risk, and sex hormones, insulin sensitivity and adipocytokines are implicated in the pathogenesis of pediatric NAFLD. The natural history of NAFLD in children is still poorly understood, because of its complex nature and the scarcity of prospective studies, especially in pediatric populations. Both genetic and environmental factors seem to be implicated in the development and progression of the disease via multiple mechanisms that involve liver crosstalk with other organs and tissues, especially gut and adipose tissue. To evaluate and effectively treat pediatric NAFLD, the pathophysiology and natural history of the disease should be clarified and noninvasive methods for screening, diagnosis, and longitudinal assessment developed.
Paralelno sa porastom prevalence gojaznosti i metaboličkog sindroma, nealkoholna masna bolest jetre (NMBJ) sve se više prepoznaje kao najčešća hepatopatija kod odraslih i dece. Tačna prevalenca pedijatrijske NMBJ još je nepoznata, usled heterogenosti dijagnostičkih metoda korišćenih za postavljanje dijagnoze u dostupnim studijama i različitih karakteristika ispitivanih populacija. Pedijatrijska NMBJ obično je primarno oboljenje i blisko je povezana s nekoliko odlika metaboličkog sindroma. Starost, pol i rasa/etnička pripadnost spadaju u značajne determinante rizika, dok u patogenezi pedijatrijske NMBJ učestvuju polni hormoni, osetljivost na insulin i adipocitokini. Prirodna istorija NMBJ kod dece još nije do kraja proučena, zbog njene složene prirode i nedostatka prospektivnih studija, naročito u pedijatrijskim populacijama. Po svoj prilici, u razvoju i progresiji ove bolesti učestvuju kako genetički tako i faktori sredine preko višestrukih mehanizama koji uključuju unakrsna dejstva između jetre i ostalih organa i tkiva, pre svega crevnog i adipoznog tkiva. Kako bi se procenila i efikasno lečila pedijatrijska NBMJ, trebalo bi razjasniti patofiziologiju i prirodnu istoriju ove bolesti i razviti neinvazivne metode za skrining, dijagnostikovanje i longitudinalne procene.
Keywords: children; metabolic syndrome; nonalcoholic fatty liver disease; nonalcoholic steatohepatitis; obesity.