Hepatic steatosis in paediatric age: what it is, causes, diagnosis and treatment

By Cristiano Antonino On Dec 26, 2022

Steatosis is the most common liver disease in children. It can be prevented by not feeding children foods high in fat and sugar and by promoting regular physical activity

Liver steatosis is the most common liver disease in children

It is due to the accumulation of fat in liver cells, in quantities greater than 5%.

Approximately 3-12% of children of normal weight are affected by hepatic steatosis and this frequency increases to 70% in overweight or obese children.

It is caused by a combination of factors, primarily an unbalanced diet combined with low physical activity.

Other factors that play an important role are a family history of obesity (the so-called ‘obesogenic environment’), metabolic diseases (arterial hypertension, insulin resistance and/or glucose intolerance and dyslipidaemia) and genetic predisposition.

In the latter case, there are gene polymorphisms such as PNPLA3 involved in the genesis and progression from hepatic steatosis to the more severe form, i.e. non-alcoholic steatohepatitis (NASH = non-alcoholic steatoheapatitis).

It is characterised by the presence not only of steatosis but also of inflammation that may evolve into irreversible chronic liver disease, with the onset of fibrosis, i.e. the replacement of damaged liver cells with connective tissue that may lead to cirrhosis.

It is almost always asymptomatic.

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Children rarely complain of abdominal pain and asthenia

Sometimes a modest increase in liver volume can be detected during the paediatric examination.

Symptoms and signs are usually related to complications such as arterial hypertension with evidence of hypertrophy of the left ventricle of the heart (detected on the electrocardiogram) up to actual cardiovascular problems.

Increasingly frequent is the presence of insulin resistance manifested by the finding of acanthosis nigricans (brownish discolouration of the skin) at the folds and dyslipidaemia (LDL and triglycerides above the 95th percentile for age) linked to the accumulation of fat in the liver.

The diagnosis is based on the sometimes finding of an enlarged liver and increased transaminase values (ALT and AST >40 IU/L) but always with the presence of hepatic steatosis on abdominal ultrasound

However, all other diseases that may give the same signs, such as Wilson’s disease, coeliac disease, thyroid diseases such as autoimmune thyroiditis and chronic viral hepatitis such as hepatitis B, must be excluded.

To diagnose steatosis and distinguish it from the more serious non-alcoholic steatohepatitis the gold standard remains liver biopsy, although new ultrasound techniques are increasingly sensitive to the study of fibrosis (ARFI, Fibroscan).