Liver Disease Research Paper
Pediatric non alcoholic fatty liver disease:
Increasing awareness in the primary care setting
By Hanna Sauer, RN, BSN
495 Cicada Court, Reno, NV 89521
(775) 303 4779
[email protected] Abstract: Non alcoholic fatty liver disease
(NAFLD) can lead to cirrhosis and hepatocellular carcinoma in children and
adolescents. Primary care providers have a unique position to identify and screen for
the disease in its early stages. This article provides an overview of prevalence, expert
guidelines, screening, treatment, and implications for the advanced practice
registered nurse (APRN).
Introduction
Non alcoholic fatty liver disease (NAFLD) is a major complication of childhood ...
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According to a landmark article by Browning et al, prevalence of NAFLD was
described as being highest in the Hispanic population and lowest among Black
Americans, and Caucasians with an intermediate prevalence. The differences were
thought to be related to insulin resistance, visceral adiposity, genetics and
socioeconomic status9.
Overnutrition, specifically excessive consumption of fructose, is fundamental to
NAFLD development10. Fructose metabolism, unlike glucose, occurs nearly
exclusively in the liver and is preferentially selected for lipogenesis. The triglyceride
production and storage that results from fructose ingestion is highly associated with
central obesity, dyslipidemia, and insulin resistance11. This relevant finding is
especially important to clinicians, as this modifiable risk factor may be easily
addressed.
Screening Guidelines and Recommendations
The majority of children with NAFLD are asymptomatic. Occasionally patients may
complain of vague abdominal pain, fatigue, or malaise, however, liver disease is
usually found incidentally on physical exam or routine lab work1. Children may
have mild to moderate hepatomegaly; however, the majority of these children are
overweight or obese, making liver palpation a challenge. In addition to obesity and
visceral adiposity, children with NAFLD often present with acanthosis nigricans on
the back of their neck or intertrigenous areas, which is suggestive of insulin