NAFLD in Children: Unique Aspects and Controversies

Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease in children. Its increasing prevalence is, of course, closely tied to the epidemic of childhood obesity. Here, we discuss unique aspects and area of controversies regarding the utility of preventive screening and the inherent limitations of the current screening tools available. We further discuss the importance of a thorough workup and the critical importance of a multidisciplinary approach. We go on to emphasize that diet and exercise are the cornerstones of NAFLD management in pediatrics while acknowledging the limitations of lifestyle interventions and the barriers to their successful implementation. We recognize that the lack of effective medical therapy is likely secondary to the pediatric NAFLD heterogeneity and the lack of stratification based on patients’ phenotypes. Lastly, we highlight the emerging role of bariatric surgery in adolescents with steatohepatitis (NASH) and morbid obesity, review the success achieved with sleeve gastrectomy in recent years and the emerging role of endoscopic bariatric surgery.