Información del artículo
Abstract
Liver steatosis, also called non-alcoholic fatty liver, is characterized by a pathological fat accumulation in the liver, leading to liver damage in the form of inflammation and fibrosis. These histological features are similar to those in alcoholic hepatitis. Obesity is known to be the most common cause of simple steatosis in the preadolescent and adolescent population with a consequent serious health risk. The aim of this study was to provide an update on the concepts, pathophysiology and clinical management of hepatic steatosis secondary to obesity at an early age.
Keywords:
Non-alcoholic steatohepatitis
Obesity
Adolescence
Clinical management
Resumen
La esteatosis hepática también denominada hígado graso no alcohólico constituye una entidad clínica patológica caracterizada por una acumulación de componente graso a nivel hepático, circunstancia que implicará necesariamente el desarrollo de un deterioro hepático en forma de inflamación y fibrosis, características histológicas éstas similares a las originadas en una hepatitis alcohólica. En la actualidad se sabe que la obesidad constituye la causa más frecuente de esteatosis hepática simple entre la población preadolescente y adolescente con el consiguiente riesgo que ello supone para la salud de nuestra población juvenil. El objetivo de este trabajo es ofrecer una puesta al día de los conceptos, fisiopatología y manejo clínico de una complicación tan grave como es la esteatosis hepática secundaria a estados de obesidad a edades tempranas.
Palabras clave:
Esteatohepatitis no alcohólica
Obesidad
Adolescencia
Manejo clínico
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References
[1.]
J. Ludwig, T.R. Viggiano, D.B. McGill, B.J. Oh.
Nonalcoholic steatohepatitis: May Clinic experiences with a hitherto unnamed disease.
May Clin Proc, 55 (1980), pp. 434-438
[2.]
J.R. Moran, F.K. Ghishan, S.A. Halter, H.L. Greene.
Steatohepatitis in obese children: a cause of chronic liver dysfunction.
Am J Gastroenterol, 78 (1983), pp. 374-377
[3.]
M. Lazo, J.M. Clark.
The epidemiology of nonalcoholic fatty liver disease: a global perspective.
Sem Liver Dis, 28 (2008), pp. 339-350
[4.]
J.B. Schwimmer, N. McGreal, R. Deutsch, M.J. Finegold, J.E. Lavine.
Influence of gender, race, and ethnicity on suspected fatty liver in obese adolescents.
Pediatrics, 115 (2005), pp. 561-565
[5.]
R.E. Quiros-Tejeira, C.A. Rivera, T.T. Ziba, N. Mehta, C.W. Smith, N.F. Butte.
Risk for nonalcoholic fatty liver disease in Hispanic youth with BMI > or = 95th percentile.
J Pediatr Gastroenterol Nutr, 44 (2007), pp. 228-236
[6.]
H. Hesham.
Nonalcoholic fatty liver disease in children living in the obeseogenic society.
World J Pediatr, 5 (2009), pp. 245-254
[7.]
A. Wieckowska, A.E. Feldstein.
Nonalcoholic fatty liver disease in the pediatric population: a review.
Curr Opin Pediatr, 17 (2005), pp. 636-641
[8.]
J.B. Nicole, S.F. Cameron, B.S. Jeffrey, E.L. Joel.
Nonalcoholic fatty liver disease as a comorbidity of childhood obesity.
Ped Health, 3 (2009), pp. 271-281
[9.]
K. Tominaga, J.H. Kurata, K. Chen, E. Fujimoto, S. Miyagawa, I. Abe, et al.
Prevalence of fatty liver in Japanese children and relationship to obesity. An epidemiological ultrasonographic survey.
Dig Dis Sci, 40 (1995), pp. 2002-2009
[10.]
A. Franzese, P. Vajro, A. Argenziano, A. Puzziello, M.P. Iannucci, M.C. Saviano, et al.
Liver involvement in obese chil- dren. Ultrasonography and liver enzyme levels at diagnosis and during follow-up in an Italian population.
Dig Dis Sci, 42 (1997), pp. 1428-1432
[11.]
D.F. Chan, A.M. Li, W.C. Chu, M.H. Chan, E.M. Wong, E.K. Liu, et al.
Hepatic steatosis in obese Chinese children.
Int J Obes Relat Metab Disord, 28 (2004), pp. 1257-1263
[12.]
L. Peña-Quintana, E. Colino, N. Montedeoca, D. González, I.A. Aguiar, P. Saavedra, et al.
Obesity and non-alcoholic fatty liver disease.
J Pediatr Gastroenterol Nutr, 40 (2005), pp. 686-687
[13.]
E.M. Brunt.
Alcoholic nonalcoholic steatohepatitis.
Clin Liv Dis, 6 (2002), pp. 339-420
[14.]
R.U. Macías, A. Torre.
Pathophysiology of non-alcoholic steatohepatitis. An insulin resistance overview.
Rev Invest Clin, 61 (2009), pp. 161-172
[15.]
P. Angulo.
Nonalcoholic Fatty Liver Disease.
N Eng J Med, 346 (2002), pp. 1221-1231
[16.]
L. Serra, L. Ribas, J. Aranceta, C. Pérez, P. Saavedra, L. Peña.
Obesidad infantil y juvenil en España. Resultados del Estudio enKid (1998-2000).
Med Clin (Barc), 121 (2003), pp. 725-732
[17.]
S.G. Hubscher.
Histological assessment of non-alcoholic fatty liver disease.
Histopathology, 49 (2006), pp. 450-465
[18.]
D.E. Kleiner, E.M. Brunt, M. Van Natta, C. Behling, M.J. Contos, O.W. Cummings, et al.
Nonalcoholic Steatohepatitis Clinical Research Network Design and validation of a histological scoring system for nonalcoholic fatty liver disease.
Hepatology, 41 (2005), pp. 1313-1321
[19.]
J.B. Schwimmer, C. Behling, R. Newbury, R. Deutsch, C. Nievergelt, N.J. Schork, et al.
Histopathology of pediatric nonalcoholic fatty liver disease.
Hepatology, 42 (2005), pp. 641-649
[20.]
C. Day, O. James.
Steatohepatitis: a tale of two hits?.
Gastroenterology, 114 (1998), pp. 842-845
[21.]
D. Preiss, N. Sattar.
Non-alcoholic fatty liver disease: an overview of prevalence, diagnosis, pathogenesis and treatment considerations.
Clin Sci (Lond), 115 (2008), pp. 141-150
[22.]
L. Pacifico, E. Poggiogalle, V. Cantisani, G. Menichini, P. Ricci, F. Ferraro, et al.
Pediatric nonalcoholic fatty liver disease: A. clinical laboratory Challenger.
World J Hepatol, 2 (2010), pp. 275-288
[23.]
V. Nobili, M. Pinzani.
Paediatric non-alcoholic fatty liver disease.
Gut, 59 (2010), pp. 561-564
[24.]
R. Weiss, J. Dziura, T.S. Burgert, W.V. Tamborlane, S.E. Taksali, C.W. Yeckel, et al.
Obesity and the metabolic syndrome in children and adolescents.
N Engl J Med, 350 (2004), pp. 2362-2374
[25.]
S.D. De Ferranti, K. Gauvreau, D.S. Ludwig, E.J. Neufeld, J.W. Newburger, N. Rifai.
Prevalence of the metabolic syndrome in American adolescents: findings from the Third National Health and Nutrition Examination Survey.
Circulation, 110 (2004), pp. 2494-2497
[26.]
A. Iacobellis, M. Marcellini, A. Andriulli, F. Perri, G. Leandro, R. Devito, et al.
Non invasive evaluation of liver fibrosis in paediatric patients with nonalcoholic steatohepatitis.
World J Gastroenterol, 12 (2006), pp. 7821-7825
[27.]
J.J. Díez, P. Iglesias.
The role of the novel adipocyte derived hormone adiponectin in human disease.
European Journal of Endocrinology, 148 (2003), pp. 293-300
[28.]
J.M. Hui, A. Hodge, G.C. Farell, J.G. Kench, A. Kriketos, J. George.
Beyond insuline resistance in NASH: TNF alfa or adiponectin?.
Hepatology, 40 (2004), pp. 46-54
[29.]
S. Kaser, A. Moschen, A. Cayon, A. Kaser, J. Crespo, F. Pons Romero, et al.
Adiponectin and its receptors in non alcoholic steatohepatitis.
Gut, 54 (2005), pp. 117-121
[30.]
S.K.J. Erickson.
Nonalcoholic fatty liver disease.
Lipid Res, 50 (2009), pp. 412-416
[31.]
P. Sathya, M. Steven, F. Álvarez.
Nonalcoholic fatty liver disease (NAFLD) in children.
Curr Opin Pediatr, 14 (2002), pp. 593-600
[32.]
R.U. Macías-Rodríguez, A. Torre.
Pathophysiology of non-alcoholic steatohepatitis. An insulin resistance overview.
Rev Invest Clin, 61 (2009), pp. 161-172
[33.]
O. Cheung, A.J. Sanyal.
Recent advances in nonalcoholic fatty liver disease.
Curr Opin Gastroenterol, 25 (2009), pp. 230-237
[34.]
R. Vuppalanchi, N. Chalasani.
Non alcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practi- cal issues in their evaluation and management.
Hepatology, 49 (2009), pp. 306-317
[35.]
J.P. Bastard, M. Maachi, C. Lagathu, M.J. Kim, M. Caron, H. Vidal, et al.
Recent advances in the relationship between obesity, inflammation, and insulin resistance.
Eur Cytokine Netw, 17 (2006), pp. 4-12
[36.]
A. Wieckowska, A.J. McCullough, A.E. Feldstein.
Noninvasive diagnosis and monitoring of nonalcoholic steatohepatitis: present and future.
Hepatology, 46 (2007), pp. 582-589
[37.]
M.H. Fishben, M. Miner, Ch Mogren, J. Chalekson.
The spectrum of fatty liver in obese children and the relationship of serum aminotransferase to sensitivity of steatosis.
J Pediatr Gastroenterol Nutr, 36 (2003), pp. 54-61
[38.]
H. Tilg, A.R. Moschen.
Insulin resistance, inflammation, and nonalcoholic fatty liver disease.
Trends Endocrinol Metab, 19 (2008), pp. 371-379
[39.]
M. Tobari, E. Hashimoto, S. Yatsuji, N. Torii, K. Shiratori.
Ima- ging of nonalcoholic steatohepatitis: advantages and pitfalls of ultrasonography and computed tomography.
Intern Med, 48 (2009), pp. 739-746
[40.]
D.G. Duman, C. Celikel, D. Tuney, N. Imeryuz, E. Avsar, N. Tozun.
Computed tomography in nonalcoholic fatty liver disease: a useful tool for hepatosteatosis assessment?.
Dig Dis Sci, 51 (2006), pp. 346-351
[41.]
M. Fishbein, F. Castro, S. Cheruku, S. Jain, B. Webb, T. Gleason, W.R. Stevens.
Hepatic MRI for fat quantitation: its relationship to fat morphology, diagnosis, and ultrasound.
J Clin Gastroenterol, 39 (2005), pp. 619-625
[42.]
D. Joy, V.R. Thava, B.B. Scott.
Diagnosis of fatty liver disease: is biopsy necessary?.
Eur J Gastroenterol Hepatol, 15 (2003), pp. 539-543
[43.]
J. Foucher, L. Castera, P.H. Bernard, X. Adhoute, D. Laharie, J. Bertet, et al.
Prevalence and factors associated with failure of liver stiffness measurement using FibroScan in a prospective study of 2114 examinations.
Eur J Gastroenterol Hepatol, 18 (2006), pp. 411-412
[44.]
M. Munteanu, V. Ratziu, R. Morra, D. Messous, F. Imbert-Bismut, T. Poynard.
Noninvasive biomarkers for the screening of fibrosis, steatosis and steatohepatitis in patients with metabolic risk factors: FibroTest-FibroMax experience.
J Gastrointestin Liver Dis, 17 (2008), pp. 187-191
[45.]
A. Baranova, L. Liotta, E. Petricoin, Z.M. Younossi.
The role of genomics and proteomics: technologies in studying nonalcoholic fatty liver disease.
Clin Liver Dis, 11 (2007), pp. 209-220
[46.]
M. Charlton, K. Viker, A. Krishnan, S. Sanderson, B. Veldt, A.J. Kaalsbeek, et al.
Differential expression of lumican and fatty acid binding protein-1: new insights into the histologic spectrum of nonalcoholic fatty liver disease.
Hepatology, 49 (2009), pp. 1375-1384
[47.]
S. Dam-Larsen, M. Franzmann, I.B. Andersen, P. Christoffersen, L.B. Jensen, T.I. Sorensen, et al.
Long term prognosis of fatty liver: risk of chronic liver disease and death.
Gut, 53 (2004), pp. 50-55
[48.]
A.E. Feldstein, P. Charatcharoenwitthaya, S. Treeprasertsuk, J.T. Benson, F.B. Enders, P. Angulo.
The natural history of nonalcoholic fatty liver disease in children: a follow-up study for up to 20 years.
Gut, 58 (2009), pp. 1538-1544
[49.]
G.C. Farrell, C.Z. Larter.
Nonalcoholic fatty liver disease: from steatosis to cirrhosis.
Hepatology, 43 (2006), pp. 99-112
[50.]
J.P. Molleston, F. White, J. Teckman, J.F. Fitzgerald.
Obese children with steatohepatitis can develop cirrhosis in childhood.
Am J Gastroenterol, 97 (2002), pp. 2460-2462
[51.]
M. Machado, P. Marques-Vidal, H. Cortez-Pinto.
Hepatic histology in obese patients undergoing bariatric surgery.
J Hepatol, 45 (2006), pp. 600-606
[52.]
O. Cheung, A.J. Sanval.
Recent advances in nonalcoholic fatty liver disease.
Curr Opin Gastroenterol, 25 (2008), pp. 230-237
[53.]
R. Loomba, C.B. Sirlin, J.B. Schwimmer, J.E. Lavine.
Advances in pediatric nonalcoholic fatty liver disease.
Hepatology, 50 (2009), pp. 1282-1293
[54.]
H.M. Patton, C. Sirlin, C. Behling, M. Middleton, J.B. Schwimmer, J.E. Lavine.
Pediatric nonalcoholic fatty liver disease: a critical appraisal of current data and implications for future research.
J Pediatr Gastroenterol Nutr, 43 (2006), pp. 413-427
[55.]
E. Fabbrini, S. Sullivan, S. Klein.
Obesity and nonalcoholic fatty liver disease: biochemical, metabolic, and clinical implications.
Hepatology, 51 (2010), pp. 679-689
[56.]
V. Nobili, M. Manco, V. Di Ciommo, D. Comparcola, M.R. Sartorelli, F. Piemonte, et al.
Lifestyle intervention and antioxidant therapy in children with nonalcoholic fatty liver disease: A randomized, controlled trial.
Hepatology, 48 (2008), pp. 119-128
[57.]
P. Vajro, A. Franzese, G. Valerio, M.P. Iannucci, N. Aragione.
Lack of efficacy of ursodeoxycholic acid for the treatment of liver abnormalities in obese children.
J Pediatr, 136 (2000), pp. 739-743
[58.]
J.B. Schwimmer, M.S. Middleton, R. Deutsch, J.E. Lavine.
A phase 2 clinical trial of metformin as a treatment for non-diabetic paediatric non-alcoholic steatohepatitis.
Aliment Pharmacol Ther, 21 (2005), pp. 871-879
[59.]
J.E. Lavine.
Vitamin E treatment of nonalcoholic steatohepatitis in children: a pilot study.
J Pediatr, 136 (2000), pp. 734-738
[60.]
K. Nanda.
Non-alcoholic steatohepatitis in children.
Pediatr Transplant, 8 (2004), pp. 613-618
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