The Evaluation of Hepatic Fibrosis Scores in Children with Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States. Childhood NAFLD is associated with hepatic and non-hepatic morbidity and mortality. Non-hepatic associations included cardiovascular, metabolic, pulmonary and psychological disorders. Cardiovascular conditions observed in childhood include left ventricular dysfunction. Furthermore, childhood obesity is associated with greater odds of having hepatocellular carcinoma as an adult. Evidence suggests that NAFLD may begin in utero in children of diabetic mothers. However, NAFLD typically is diagnosed between the ages of 10–13 years. The actual onset of disease for most children is not known. At diagnosis 10–25% of children can have advanced fibrosis. In the most severe cases, children can progress within a few years to cirrhosis and end-stage liver disease. Quality longitudinal data of the natural history of pediatric NAFLD are limited. Available data suggest that children with NAFLD are at risk for higher mortality rates as young adults. However, NAFLD is a heterogeneous disease and natural history is expected to vary considerably from child to child. Thus rigorous efforts for structured diagnosis and follow-up are a priority to better develop the understanding of outcomes in pediatric NAFLD needed to provide accurate counseling to children and their families.

The tested non-invasive fibrosis scoring systems, some of which were originally designed for adult populations, did not adequately predict fibrosis in a paediatric cohort. Further development of risk prediction scores in children are needed for the management of paediatric patients and will likely need to be developed within a large paediatric data set in order to improve specificity and sensitivity.

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