Pediatric obesity and the liver

Non-alcoholic fatty liver disease (NAFLD) is a frequent complication of obesity. In some of those with NAFLD, the fat accumulation in the liver will cause inflammation and fibrosis and can ultimately cause liver failure. In addition, in adults it has been established that NAFLD increases the risk of cardiovascular disease.
This thesis evaluates the current diagnostic tools, treatment and complications of NAFLD in severely obese children. For this purpose 135 children were screened for NAFLD before and after a lifestyle intervention to treat their obesity.
Diagnosing NAFLD using ultrasound in this group has a fair negative predictive value and poor positive predictive value. Also currently available biomarkers and prediction scores, formulas containing clinical and biochemical parameters, have insufficient accuracy for diagnosing NAFLD.
An intensive lifestyle intervention (diet, physical exercise and psychological consultation) only leads to complete regression on NAFLD in a minority of patients. Early signs of atherosclerosis were not observed in those with NAFLD and the risk of gallstones, also after lifestyle treatment, was low in this group.
In conclusion, improvement in both diagnostics and treatment of NAFLD is needed. To achieve this goal, targeted therapy based on individual pathogenic mechanisms in NAFLD needs to be developed.