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World J Gastroenterol. Dec 21, 2017; 23(47): 8277-8282
Published online Dec 21, 2017. doi: 10.3748/wjg.v23.i47.8277
Obese children with fatty liver: Between reality and disease mongering
Giusy Ranucci, Maria Immacolata Spagnuolo, Raffaele Iorio
Giusy Ranucci, Maria Immacolata Spagnuolo, Raffaele Iorio, Department of Translational Medical Science, Section of Pediatrics, University Federico II, Naples 80131, Italy
Author contributions: All authors contributed to the manuscript.
Conflict-of-interest statement: Authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Raffaele Iorio, MD, Associate Professor, Department of Translational Medical Science, Section of Pediatrics, University Federico II, Via Pansini 5, Naples 80131, Italy. riorio@unina.it
Telephone: +39-81-7464337 Fax: +39-81-7464337
Received: October 23, 2017
Peer-review started: October 24, 2017
First decision: November 8, 2017
Revised: November 14, 2017
Accepted: December 4, 2017
Article in press: December 4, 2017
Published online: December 21, 2017
Processing time: 57 Days and 13.5 Hours
Abstract

Following the current epidemic of obesity, the worldwide prevalence of nonalcoholic fatty liver disease (NAFLD) has increased with potential serious health implications. While it is established that in adults NAFLD can progress to end-stage liver disease in many cases, the risk of progression during childhood is less well defined. Since most obese children are not adherent to lifestyle modifications and hypocaloric diets, there is a growing number of studies on pharmacological interventions with the risk of disease mongering, the practice of widening the boundaries of illness in order to expand the markets for treatment. Here, we propose a critical appraisal of the best available evidence about long-term course of pediatric NAFLD and efficacy of treatments other than hypocaloric diet and physical exercise. As a result, the number of NAFLD children with a poor outcome is small in spite of the alarming tones used in some papers; large-scale longitudinal studies with long-term follow-up of pediatric NAFLD patients are lacking; the studies on ancillary pharmacological interventions have been performed in few patients with inconclusive and conflicting results.

Keywords: Obesity; Children; Non alcoholic fatty liver disease; Non alcoholic steatohepatitis; Cirrhosis; Liver transplant; Disease mongering

Core tip: The number of obese children with nonalcoholic fatty liver with a documented poor outcome is small in spite of the alarming tones used in some papers. The available studies are insufficient to determine whether or not children with nonalcoholic fatty liver have an elevated risk of developing detrimental health conditions. Large-scale longitudinal studies with long-term follow-up of children with nonalcoholic fatty liver are desirable. Since most obese children are not adherent to lifestyle modifications and hypocaloric diets, there is a growing number of studies on pharmacological interventions with the risk of disease mongering, the practice of widening the boundaries of illness in order to expand the markets for treatment. The studies on ancillary pharmacological interventions, in addition to diet and exercise, have been performed in few children with inconclusive and conflicting results. The proposal to the obese patient of an ancillary drug may divert his attention from the diet and exercise.