Non alcoholic fatty Liver disease in children and adolescents with type 1 diabetes: Clinical, diagnostic and management aspects
Hoda Atwa
Suez Canal University, Egypt
: Endocrinol Diabetes Res
Abstract
NAFLD is characterized by excessive hepatic fat accumulation. NAFLD includes two pathologically distinct conditions: nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). The definition of nonalcoholic fatty liver disease (NAFLD) requires that there is evidence of hepatic steatosis and that there are no causes for secondary hepatic fat accumulation. The prevalence of NAFLD varies by sensitivity of the diagnostics methods used and characteristics of population such as age, sex distribution, duration of diabetes, family history of T2D, BMI and degree of glycaemic control. NAFLD in T1D is characterized by an altered portosystemic gradient of insulin and lower degree of insulin resistance than T1D. Although the majority of patients with NAFLD are asymptomatic, some may present with nonspecific symptoms. NAFLD remains a diagnosis of exclusion. Liver enzymes may not be elevated in all cases of NAFLD, and the level of aminotransferases does not reliably predict the extent of inflammation and cirrhosis. Hepatic MRI can give insight into the extent of liver involvement in NAFLD. Scores developed to predict steatosis are not accurate enough. Staging of hepatic fibrosis is the strongest predictor of disease specific mortality. NAFLD has been associated with an increased prevalence of both microand macrovascular complications in patients with T1D. Medical nutrition therapy lifestyle modification is a safe and effective means of treating and preventing NAFLD. Pharmacological treatment may be required. No currently available medications have been proven to benefit the majority of children with NAFLD. A variety of new drugs are likely to emerge, permitting a more stage-based approach to NAFLD management. Patients with simple fatty change had no increase in mortality, whereas patients with NASH had reduced survival and more cases died from cardiovascular disease than liver related disease.
Biography
E-mail: atwahoda@gmail.com
