Recognition and management of children with nonalcoholic fatty liver disease

Objective: To review diagnostic challenges and management strategies in children with nonalcoholic fatty liver disease (NAFLD). Methods: Review of the literaure. Results: NAFLD is common in the United States and should be suspected in overweight or obese children with an elevated serum alanine aminotransferase level. The differential diagnosis for these patients is broad, however, and liver biopsy-the gold standard test-should be undertaken selectively after an appropriate workup. Patients should be counseled on lifestyle modifications, whereas Vitamin E therapy can be initiated for those with biopsy-proven disease. Conclusion: Providers should have a high degree of suspicion for NAFLD, approaching the workup and diagnosis in an incremental, step-wise fashion. Further research is needed to standardize the diagnostic approach, identify reliable, noninvasive diagnostic measures, and develop novel treatment modalities.