Non-alcoholic Steatohepatitis over Multiple Generations

Excerpt

Non-alcoholic fatty liver disease (NAFLD) is an increasingly recognized form of chronic liver disease in both adults and children that can progress to end-stage liver disease. NAFLD encompasses a spectrum of conditions associated with an over-accumulation of fat in the liver. It ranges from steatosis, to NASH or non-alcoholic steatohepatitis, to advanced fibrosis and cirrhosis. Long-term longitudinal studies in the adult population suggest that while simple fatty liver is a benign condition, NASH may progress to cirrhosis and end-stage liver disease. NAFLD is strongly associated with obesity and insulin resistance and is currently considered by many as the hepatic component of the metabolic syndrome. The importance of this observation is emphasized by the fact that in the United States and most of the Western world, childhood obesity has reached an epidemic proportion, which could potentially make NAFLD the most common liver condition in the pediatric population. The natural history of this condition in children remains poorly understood, but cross-sectional studies and case reports have confirmed that children with NAFLD may develop cirrhosis during childhood. Thus, it is of great importance to identify those patients at particular risk for the more serious forms of this condition in order to select those patients who would benefit the most from therapeutic interventions and frequent monitoring of disease status. Recent studies demonstrating significant ethnic differences in the prevalence of NAFLD and NAFLD-related cirrhosis strongly suggest that susceptibility to NAFLD and progressive disease may have a genetic component. …