AAP News TODAY 2016 - Sunday, October 23, 2016 - 9
AAPexperience.org | 9
Liver Disease in Children Can Progress With No Symptoms
Symptomatic chronic liver disease
is uncommon in children, said David
Brumbaugh, MD, MSCI, FAAP, a member
of the AAP Section on Gastroenterology,
Hepatology and Nutrition.
"However, an important clinical
challenge is the fact that liver disease can
insidiously progress without symptoms for
years and decades, eventually contributing
to major morbidity in adulthood," he said.
Dr. Brumbaugh will provide an update on liver abnormalities in overweight
children and adolescents during a session
titled "Fatty Liver, a Sign of Food Toxicity? (F2151)" from 3:00-3:45 pm today in
Room 309 of Moscone South.
Examples of liver disease that can progress without symptoms are viral infections
such as hepatitis B and C as well as non-alcoholic fatty
to a spectrum
of fatty liver
fat deposition in the liver to non-alcoholic
steatohepatitis (NASH), an inflammatory
state that can progress to fibrosis and cirrhosis, Dr. Brumbaugh explained. NAFLD
affects an estimated 8%-10% of 12- to
18-year-olds in the U.S.
Studies have shown that NAFLD is
strongly associated with obesity.
"Interestingly, there are also important differences in NAFLD prevalence according to
race/ethnicity and sex. Hispanic-Americans
and males are more likely to be affected,"
said Dr. Brumbaugh, assistant professor of
pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado School of Medicine.
Because most patients with NAFLD are
asymptomatic, screening obese patients
beginning at 9-11 years for obesity-related
comorbidities is an important opportunity
to address this problem, he said.
During the session, Dr. Brumbaugh
will discuss screening tests for liver disease,
including alanine aminotransferase (ALT).
While ALT has emerged as the consensus
screening test for NAFLD, it is limited in its
sensitivity and is not specific for NAFLD.
"In the setting of the obese patient,
NAFLD is going to be by far and away the
most common cause of ALT elevation," Dr.
Brumbaugh said. "However, when the ALT
is persistently elevated, it is important to
maintain a differential diagnosis and not
miss other causes of chronic liver disease in
Diet and weight reduction remain the
mainstay of treatment for NAFLD, he said.
Patients should be encouraged to reduce
their intake of beverages high in fructose,
which potentiates the creation of lipid
within the liver. In addition, weight loss
Moscone South, Room 309
should be pursued gradually through calorie
reduction and increased physical activity.
"Rapid weight loss as part of an over
aggressive dietary strategy can counterproductively cause excess fat release from
Liver Disease, see page 13
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