Non-alcoholic fatty liver disease in children Towards an effective screening strategy

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disorder in children and adults worldwide and is highly associated with obesity. This disease has a long asymptomatic course until severe complications occur, such as liver cirrhosis, liver failure or hepatocellular carcinoma. Liver fibrosis has been established as the most important predictor of liver related and overall morbidity and mortality in NAFLD. Screening for NAFLD and fibrosis and intensifying treatment in those at risk of severe disease could prevent important future morbidity and mortality. This thesis is aimed at optimizing screening for pediatric NAFLD by closing the gaps of knowledge that currently hampers effective screening. In the first part, the diagnostic accuracy of several non-invasive methods for detecting steatosis and fibrosis in children with obesity is assessed. Part II focusses on screening practices in the Netherlands. These chapters describe the results of a survey among Dutch pediatricians on their screening practices, and a retrospective study on patient compliance and physicians’ adherence to a screening strategy in the largest outpatient obesity clinic in Amsterdam. Furthermore, barriers for screening were identified in focus group discussions with healthcare workers at obesity clinics. Part III describes the long-term hepatic and non-hepatic outcomes of a cohort of adolescents who had childhood obesity and were screened for NAFLD 10 years ago using non-invasive tests.