26 - World Journal of Gastroenterology

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doi:10.3748/wjg.v17.i26.3082
Pediatric nonalcoholic fatty liver disease, metabolic
syndrome and cardiovascular risk
Lucia Pacifico, Valerio Nobili, Caterina Anania, Paola Verdecchia, Claudio Chiesa
Lucia Pacifico, Caterina Anania, Paola Verdecchia, Department
of Pediatrics, Sapienza University of Rome, 00161-Rome, Italy
Valerio Nobili, Department of Hepato-gastroenterology and
Nutrition, Pediatric Hospital “Bambino Gesù”, Rome, Italy
Claudio Chiesa, Institute of Translational Pharmacology, National
Research Council, 00133-Rome, Italy
Author contributions: Pacifico L, Anania C and Chiesa C
designed the study; Anania C, Verdecchia P and Nobili V were
responsible for acquisition, analysis and interpretation of data;
Pacifico L, Anania C and Verdecchia P drafted the manuscript;
Pacifico L, Nobili V and Chiesa C prepared the final version
of the manuscript; Chiesa C and Nobili V critically revised the
manuscript for important intellectual content; all authors approved
the final version of the manuscript.
Correspondence to: Claudio Chiesa, MD, Institute of Translational
Pharmacology, National Research Council, Via del Fosso del
Cavaliere, 100, I-00133 Rome, Italy. claudio.chiesa@ift.cnr.it
Telephone: +39-6-49979215 Fax: +39-6-49979216
Received: February 2, 2011 Revised: March 21, 2011
Accepted: March 28, 2011
Published online: July 14, 2011
Abstract
Nonalcoholic fatty liver disease (NAFLD) encompasses
a range of liver histology severity and outcomes in the
absence of chronic alcohol use. The mildest form is
simple steatosis in which triglycerides accumulate within
hepatocytes. A more advanced form of NAFLD, nonalcoholic
steatohepatitis, includes inflammation and
liver cell injury, progressive to cryptogenic cirrhosis.
NAFLD has become the most common cause of chronic
liver disease in children and adolescents. The recent
rise in the prevalence rates of overweight and obesity
likely explains the NAFLD epidemic worldwide. NAFLD
is strongly associated with abdominal obesity, type 2
diabetes, and dyslipidemia, and most patients have evidence
of insulin resistance. Thus, NAFLD shares many
features of the metabolic syndrome (MetS), a highly
atherogenic condition, and this has stimulated interest
in the possible role of NAFLD in the development of
atherosclerosis. Accumulating evidence suggests that
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3082
World J Gastroenterol 2011 July 14; 17(26): 3082-3091
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2011 Baishideng. All rights reserved.
REVIEW
NAFLD is associated with a significantly greater overall
mortality than in the general population, as well as with
increased prevalence of cardiovascular disease (CVD),
independently of classical atherosclerotic risk factors.
Yet, several studies including the pediatric population
have reported independent associations between
NAFLD and impaired flow-mediated vasodilatation and
increased carotid artery intimal medial thickness-two reliable
markers of subclinical atherosclerosis-after adjusting
for cardiovascular risk factors and MetS. Therefore,
the rising prevalence of obesity-related MetS and NAFLD
in childhood may lead to a parallel increase in adverse
cardiovascular outcomes. In children, the cardiovascular
system remains plastic and damage-reversible if early
and appropriate interventions are established effectively.
Therapeutic goals for NAFLD should address nutrition,
physical activity, and avoidance of smoking to prevent
not only end-stage liver disease but also CVD.
© 2011 Baishideng. All rights reserved.
Key words: Nonalcoholic fatty liver disease; Metabolic
syndrome; Cardiovascular risk; Children
Peer reviewers: Eyvind J Paulssen, MD, PhD, Department
of Gastroenterology, University Hospital of North Norway, PO
Box 83, Tromsø, N-9038, Norway; Yoshihisa Takahashi, MD,
Department of Pathology, Teikyo University School of Medicine,
2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
Pacifico L, Nobili V, Anania C, Verdecchia P, Chiesa C. Pediatric
nonalcoholic fatty liver disease, metabolic syndrome and
cardiovascular risk. World J Gastroenterol 2011; 17(26): 3082-3091
Available from: URL: http://www.wjgnet.com/1007-9327/full/v17/
i26/3082.htm DOI: http://dx.doi.org/10.3748/wjg.v17.i26.3082
INTRODUCTION
Over the last two decades, the rise in the prevalence rates
of overweight and obesity may explain the emergence of
nonalcoholic fatty liver disease (NAFLD) as the leading
July 14, 2011|Volume 17|Issue 26|