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Fatty liver disease in children: eat now pay later

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Abstract

Introduction

With the recent epidemic in childhood obesity, nonalcoholic fatty liver disease (NAFLD) has become an emerging problem and a common cause of chronic liver disease in children.

Methods

In this review, the most recent insights on the pathogenesis, diagnosis, natural history, and treatment of NAFLD in children are discussed.

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References

  1. Ludwig R. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed. Mayo Clin Proc 1980;55:434–438

    CAS  PubMed  Google Scholar 

  2. Moran JR, Ghishan FK, Halter SA, Greene HL. Steatohepatitis in obese children: a cause of chronic liver dysfunction. Am J Gastroenterol 1983;78:374–377

    CAS  PubMed  Google Scholar 

  3. Reilly JJ. Diagnostic accuracy of the BMI for age in paediatrics. Int J Obes 2006;30:595–597

    Article  CAS  Google Scholar 

  4. Stamatakis E, Primatesta P, Chinn S, Rona R, Falascheti E. Overweight and obesity trends from 1974 to 2003 in English children: what is the role of socioeconomic factors? Arch Dis Child 2005;90:999–1004

    Article  CAS  PubMed  Google Scholar 

  5. Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999–2000. JAMA 2002;288:1728–1732

    Article  PubMed  Google Scholar 

  6. Patton HM, Sirlin C, Behling C, Middleton M, Schwimmer JB, Lavine JE. Pediatric nonalcoholic fatty liver disease: a critical appraisal of current data and implications for future research. J Pediatr Gastroenterol Nutr 2006;43:413–427

    Article  PubMed  Google Scholar 

  7. Prati D, Taioli E, Zanella A, Della Torre E, Butelli S, Del Vecchio E, et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med 2002;137:1–10

    CAS  PubMed  Google Scholar 

  8. Rashid M, Roberts EA. Nonalcoholic steatohepatitis in children. J Pediatr Gastroenterol Nutr 2000;30:48–53

    Article  CAS  PubMed  Google Scholar 

  9. Schwimmer JB, Behling C, Newbury R, Deutsch R, Nievergelt C, Schork NJ, et al. Histopathology of pediatric nonalcoholic fatty liver disease. Hepatology 2005;42:641–649

    Article  PubMed  Google Scholar 

  10. Fraser A, Longnecker MP, Lawlor DA. Prevalence of elevated alanine aminotransferase among US adolescents and associated factors: NHANES 1999–2004. Gastroenterology 2007;133:1814–1820

    Article  CAS  PubMed  Google Scholar 

  11. Tominaga K, Kurata JH, Chen YK, Fujimoto E, Miyagawa S, Abe I, et al. Prevalence of fatty liver in Japanese children and relationship to obesity. An epidemiological ultrasonographic survey. Dig Dis Sci 1995;40:2002–2009

    Article  CAS  PubMed  Google Scholar 

  12. Park HS, Han JH, Choi KM, Kim SM. Relation between elevated serum alanine aminotransferase and metabolic syndrome in Korean adolescents. Am J Clin Nutr 2005;82:1046–1051

    CAS  PubMed  Google Scholar 

  13. Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of fatty liver in children and adolescents. Pediatrics 2006;118:1388–1393

    Article  PubMed  Google Scholar 

  14. Strauss RS, Barlow SE, Dietz WH. Prevalence of abnormal serum aminotransferase values in overweight and obese adolescents. J Pediatr 2000;136:727–733

    Article  CAS  PubMed  Google Scholar 

  15. Quiros-Tejeira RE, Rivera CA, Ziba TT, Mehta N, Smith CW, Butte NF. Risk for nonalcoholic fatty liver disease in Hispanic youth with BMI > or =95th percentile. J Pediatr Gastroenterol Nutr 2007;44:228–236

    Article  CAS  PubMed  Google Scholar 

  16. Schwimmer JB, McGreal N, Deutsch R, Finegold MJ, Lavine JE. Influence of gender, race, and ethnicity on suspected fatty liver in obese adolescents. Pediatrics 2005;115:e561–e565

    Article  PubMed  Google Scholar 

  17. Schwimmer JB, Deutsch R, Rauch JB, Behling C, Newbury R, Lavine JE. Obesity, insulin resistance, and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease. J Pediatr 2003;143:500–505

    Article  PubMed  Google Scholar 

  18. Willner IR, Waters B, Patil SR, Reuben A, Morelli J, Riely CA. Ninety patients with nonalcoholic steatohepatitis: insulin resistance, familial tendency, and severity of disease. Am J Gastroenterol 2001;96:2957–2961

    Article  CAS  PubMed  Google Scholar 

  19. Carter-Kent C, Feldstein AE. Non-alcoholic steatohepatitis over multiple generations. Dig Dis Sci 2009 (in press)

  20. Romeo S, Kozlitina J, Xing C, Pertsemlidis A, Cox D, Pennacchio LA, et al. Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nat Genet 2008;40:1461–1465

    Article  CAS  PubMed  Google Scholar 

  21. Carulli L, Canedi I, Rondinella S, Lombardini S, Ganazzi D, Fargion S, et al. Genetic polymorphisms in non-alcoholic fatty liver disease: interleukin-6-174G/C polymorphism is associated with non-alcoholic steatohepatitis. Dig Liver Dis 2009;41:823–828

    Article  CAS  PubMed  Google Scholar 

  22. Tokushige K, Takakura M, Tsuchiya-Matsushita N, Taniai M, Hashimoto E, Shiratori K. Influence of TNF gene polymorphisms in Japanese patients with NASH and simple steatosis. J Hepatol 2007;46:1104–1110

    Article  CAS  PubMed  Google Scholar 

  23. Miele L, Beale G, Patman G, Nobili V, Leathart J, Grieco A, et al. The Kruppel-like factor 6 genotype is associated with fibrosis in nonalcoholic fatty liver disease. Gastroenterology 2008;135:282–291

    Article  CAS  PubMed  Google Scholar 

  24. Ricchi M, Odoardi MR, Carulli L, Anzivino C, Ballestri S, Pinetti A, et al. Differential effect of oleic and palmitic acid on lipid accumulation and apoptosis in cultured hepatocytes. J Gastroenterol Hepatol 2009;24:830–840

    Article  CAS  PubMed  Google Scholar 

  25. Ouyang X, Cirillo P, Sautin Y, McCall S, Bruchette JL, Diehl AM, et al. Fructose consumption as a risk factor for non-alcoholic fatty liver disease. J Hepatol 2008;48:993–999

    Article  CAS  PubMed  Google Scholar 

  26. Musso G, Gambino R, De Michieli F, Cassader M, Rizzetto M, Durazzo M, et al. Dietary habits and their relations to insulin resistance and postprandial lipemia in nonalcoholic steatohepatitis. Hepatology 2003;37:909–916

    Article  CAS  PubMed  Google Scholar 

  27. Manco M, Marcellini M, Devito R, Comparcola D, Sartorelli MR, Nobili V. Metabolic syndrome and liver histology in paediatric non-alcoholic steatohepatitis. Int J Obes 2008;32:381–387

    Article  CAS  Google Scholar 

  28. Franzese A, Vajro P, Argenziano A, Puzziello A, Iannucci MP, MC Saviano, et al. Liver involvement in obese children. Ultrasonography and liver enzyme levels at diagnosis and during follow-up in an Italian population. Dig Dis Sci 1997;42:1428–1432

    Article  CAS  PubMed  Google Scholar 

  29. Saadeh S, Younossi ZM, Remer EM, Gramlich T, Ong JP, Hurley M, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 2002;123:745–750

    Article  PubMed  Google Scholar 

  30. Fishbein M, Castro F, Cheruku S, Jain S, Webb B, Gleason T, et al. Hepatic MRI for fat quantitation: its relationship to fat morphology, diagnosis, and ultrasound. J Clin Gastroenterol 2005;39:619–625

    Article  PubMed  Google Scholar 

  31. Radetti G, Kleon W, Stuefer J, Pittschieler K. Non-alcoholic fatty liver disease in obese children evaluated by magnetic resonance imaging. Acta Paediatr 2006;95:833–837

    Article  PubMed  Google Scholar 

  32. Wieckowska A, McCullough AJ, Feldstein AE. Noninvasive diagnosis and monitoring of nonalcoholic steatohepatitis: present and future. Hepatology 2007;46:582–589

    Article  CAS  PubMed  Google Scholar 

  33. Baldridge AD, Perez-Atayde AR, Graeme-Cook F, Higgins L, Lavine JE. Idiopathic steatohepatitis in childhood: a multicenter retrospective study. J Pediatr 1995;127:700–704

    Article  CAS  PubMed  Google Scholar 

  34. Roberts EA. Non-alcoholic steatohepatitis in children. Clin Liver Dis 2007;11:155–172

    Article  PubMed  Google Scholar 

  35. Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41:1313–1321

    Article  PubMed  Google Scholar 

  36. Feldstein AE, Charatcharoenwitthaya P, Treeprasertsuk S, Benson JT, Enders FB, Angulo P. The natural history of nonalcoholic fatty liver disease in children: a follow-up study for up to 20-years. Gut 2009 (in press)

  37. Guha IN, Parkes J, Roderick PR, Harris S, Rosenberg WM. Non-invasive markers associated with liver fibrosis in non-alcoholic fatty liver disease. Gut 2006;55:1650–1660

    Article  CAS  PubMed  Google Scholar 

  38. Ciba I, Widhalm K. The association between non-alcoholic fatty liver disease and insulin resistance in 20 obese children and adolescents. Acta Paediatr 2007;96:109–112

    Article  PubMed  Google Scholar 

  39. Chan DF, Li AM, Chu WC, Chan MH, Wong EM, Liu EK, et al. Hepatic steatosis in obese Chinese children. Int J Obes Relat Metab Disord 2004;28:1257–1263

    Article  CAS  PubMed  Google Scholar 

  40. Day CP, James OF. Steatohepatitis: a tale of two “hits”? Gastroenterology 1998;114:842–845

    Article  CAS  PubMed  Google Scholar 

  41. Duvnjak M, Lerotic I, Barsic N, Tomasic V, Virovic Jukic L, Velagic V. Pathogenesis and management issues for non-alcoholic fatty liver disease. World J Gastroenterol 2007;13:4539–4550

    CAS  PubMed  Google Scholar 

  42. Lam TK, van de Werve G, Giacca A. Free fatty acids increase basal hepatic glucose production and induce hepatic insulin resistance at different sites. Am J Physiol Endocrinol Metab 2003;284:E281–E290

    CAS  PubMed  Google Scholar 

  43. Tamura S, Shimomura I. Contribution of adipose tissue and de novo lipogenesis to nonalcoholic fatty liver disease. J Clin Invest 2005;115:1139–1142

    Article  CAS  PubMed  Google Scholar 

  44. Dentin R, Pegorier JP, Benhamed F, Foufelle F, Ferre P, Fauveau V, et al. Hepatic glucokinase is required for the synergistic action of ChREBP and SREBP-1c on glycolytic and lipogenic gene expression. J Biol Chem 2004;279:20314–20326

    Article  CAS  PubMed  Google Scholar 

  45. Iizuka K, Bruick RK, Liang G, Horton JD, Uyeda K. Deficiency of carbohydrate response element-binding protein (ChREBP) reduces lipogenesis as well as glycolysis. Proc Natl Acad Sci USA 2004;101:7281–7286

    Article  CAS  PubMed  Google Scholar 

  46. Taghibiglou C, Carpentier A, Van Iderstine SC, Chen B, Rudy D, Aiton A, et al. Mechanisms of hepatic very low density lipoprotein overproduction in insulin resistance. Evidence for enhanced lipoprotein assembly, reduced intracellular ApoB degradation, and increased microsomal triglyceride transfer protein in a fructose-fed hamster model. J Biol Chem 2000;275:8416–8425

    Article  CAS  PubMed  Google Scholar 

  47. Charlton M, Sreekumar R, Rasmussen D, Lindor K, Nair KS. Apolipoprotein synthesis in nonalcoholic steatohepatitis. Hepatology 2002;35:898–904

    Article  CAS  PubMed  Google Scholar 

  48. Begriche K, Igoudjil A, Pessayre D, Fromenty B. Mitochondrial dysfunction in NASH: causes, consequences and possible means to prevent it. Mitochondrion 2006;6:1–28

    Article  CAS  PubMed  Google Scholar 

  49. Quash G, Fournet G, Reichert U. Anaplerotic reactions in tumour proliferation and apoptosis. Biochem Pharmacol 2003;66:365–370

    Article  CAS  PubMed  Google Scholar 

  50. Sanyal AJ, Campbell-Sargent C, Mirshahi F, Rizzo WB, Contos MJ, Sterling RK, et al. Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities. Gastroenterology 2001;120:1183–1192

    Article  CAS  PubMed  Google Scholar 

  51. Caldwell SH, Swerdlow RH, Khan EM, Iezzoni JC, Hespenheide EE, Parks JK, et al. Mitochondrial abnormalities in non-alcoholic steatohepatitis. J Hepatol 1999;31:430–434

    Article  CAS  PubMed  Google Scholar 

  52. Fromenty B, Robin MA, Igoudjil A, Mansouri A, Pessayre D. The ins and outs of mitochondrial dysfunction in NASH. Diabetes Metab 2004;30:121–138

    Article  CAS  PubMed  Google Scholar 

  53. Kapoor A, Sanyal AJ. Endoplasmic reticulum stress and the unfolded protein response. Clin Liver Dis 2009;13:581–590

    Article  PubMed  Google Scholar 

  54. Cai D, Yuan M, Frantz DF, Melendez PA, Hansen L, Lee J, et al. Local and systemic insulin resistance resulting from hepatic activation of IKK-beta and NF-kappaB. Nat Med 2005;11:183–190

    Article  CAS  PubMed  Google Scholar 

  55. Marra F, Bertolani C. Adipokines in liver diseases. Hepatology 2009;50:957–969

    Article  CAS  PubMed  Google Scholar 

  56. Jarrar MH, Baranova A, Collantes R, Ranard B, Stepanova M, Bennett C, et al. Adipokines and cytokines in non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2008;27:412–421

    Article  CAS  PubMed  Google Scholar 

  57. Watanabe A, Hashmi A, Gomes DA, Town T, Badou A, Flavell RA, et al. Apoptotic hepatocyte DNA inhibits hepatic stellate cell chemotaxis via toll-like receptor 9. Hepatology 2007;46:1509–1518

    Article  CAS  PubMed  Google Scholar 

  58. Paik YH, Schwabe RF, Bataller R, Russo MP, Jobin C, Brenner DA. Toll-like receptor 4 mediates inflammatory signaling by bacterial lipopolysaccharide in human hepatic stellate cells. Hepatology 2003;37:1043–1055

    Article  CAS  PubMed  Google Scholar 

  59. Utzschneider KM, Kahn SE. Review: the role of insulin resistance in nonalcoholic fatty liver disease. J Clin Endocrinol Metab 2006;91:4753–4761

    Article  CAS  PubMed  Google Scholar 

  60. Manco M, Marcellini M, Giannone G, Nobili V. Correlation of serum TNF-alpha levels and histologic liver injury scores in pediatric nonalcoholic fatty liver disease. Am J Clin Pathol 2007;127:954–960

    Article  CAS  PubMed  Google Scholar 

  61. Wieckowska A, Zein NN, Yerian LM, Lopez AR, McCullough AJ, Feldstein AE. In vivo assessment of liver cell apoptosis as a novel biomarker of disease severity in nonalcoholic fatty liver disease. Hepatology 2006;44:27–33

    Article  CAS  PubMed  Google Scholar 

  62. Diab DL, Yerian L, Schauer P, Kashyap SR, Lopez R, Hazen SL, et al. Cytokeratin 18 fragment levels as a noninvasive biomarker for nonalcoholic steatohepatitis in bariatric surgery patients. Clin Gastroenterol Hepatol 2008;6:1249–1254

    Article  CAS  PubMed  Google Scholar 

  63. Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003;38:518–526

    Article  PubMed  Google Scholar 

  64. Forns X, Ampurdanes S, Llovet JM, Aponte J, Quinto L, Martinez-Bauer E, et al. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology 2002;36:986–992

    PubMed  Google Scholar 

  65. Guechot J, Laudat A, Loria A, Serfaty L, Poupon R, Giboudeau J. Diagnostic accuracy of hyaluronan and type III procollagen amino-terminal peptide serum assays as markers of liver fibrosis in chronic viral hepatitis C evaluated by ROC curve analysis. Clin Chem 1996;42:558–563

    CAS  PubMed  Google Scholar 

  66. Hartley JL, Brown RM, Tybulewicz A, Hayes P, Wilson DC, Gillett P, et al. Hyaluronic acid predicts hepatic fibrosis in children with hepatic disease. J Pediatr Gastroenterol Nutr 2006;43:217–221

    Article  CAS  PubMed  Google Scholar 

  67. Cales P, Oberti F, Michalak S, Hubert-Fouchard I, Rousselet MC, Konate A, et al. A novel panel of blood markers to assess the degree of liver fibrosis. Hepatology 2005;42:1373–1381

    Article  PubMed  Google Scholar 

  68. Imbert-Bismut F, Ratziu V, Pieroni L, Charlotte F, Benhamou Y, Poynard T. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet 2001;357:1069–1075

    Article  CAS  PubMed  Google Scholar 

  69. Adams LA, Bulsara M, Rossi E, DeBoer B, Speers D, George J, et al. Hepascore: an accurate validated predictor of liver fibrosis in chronic hepatitis C infection. Clin Chem 2005;51:1867–1873

    Article  CAS  PubMed  Google Scholar 

  70. Nobili V, Parkes J, Bottazzo G, Marcellini M, Cross R, Newman D, et al. Performance of ELF serum markers in predicting fibrosis stage in pediatric non-alcoholic fatty liver disease. Gastroenterology 2009;136:160–167

    Article  CAS  PubMed  Google Scholar 

  71. Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology 2007;45:846–854

    Article  CAS  PubMed  Google Scholar 

  72. Harrison SA, Oliver D, Arnold HL, Gogia S, Neuschwander-Tetri BA. Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease. Gut 2008;57:1441–1447

    Article  CAS  PubMed  Google Scholar 

  73. Dixon JB, Bhathal PS, O’Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology 2001;121:91–100

    Article  CAS  PubMed  Google Scholar 

  74. Poynard T, Ratziu V, Charlotte F, Messous D, Munteanu M, Imbert-Bismut F, et al. Diagnostic value of biochemical markers (NashTest) for the prediction of non alcoholo steato hepatitis in patients with non-alcoholic fatty liver disease. BMC Gastroenterol 2006;6:34

    Google Scholar 

  75. Palekar NA, Naus R, Larson SP, Ward J, Harrison SA. Clinical model for distinguishing nonalcoholic steatohepatitis from simple steatosis in patients with nonalcoholic fatty liver disease. Liver Int 2006;26:151–156

    Article  PubMed  Google Scholar 

  76. Nobili V, Vizzutti F, Arena U, Abraldes JG, Marra F, Pietrobattista A, et al. Accuracy and reproducibility of transient elastography for the diagnosis of fibrosis in pediatric nonalcoholic steatohepatitis. Hepatology 2008;48:442–448

    Article  CAS  PubMed  Google Scholar 

  77. Fraquelli M, Rigamonti C, Casazza G, Conte D, Donato MF, Ronchi G, et al. Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease. Gut 2007;56:968–973

    Article  PubMed  Google Scholar 

  78. Manton ND, Lipsett J, Moore DJ, Davidson GP, Bourne AJ, Couper RT. Non-alcoholic steatohepatitis in children and adolescents. Med J Aust 2000;173:476–479

    CAS  PubMed  Google Scholar 

  79. Vajro P, Fontanella A, Perna C, Orso G, Tedesco M, De Vincenzo A. Persistent hyperaminotransferasemia resolving after weight reduction in obese children. J Pediatr 1994;125:239–241

    Article  CAS  PubMed  Google Scholar 

  80. Nobili V, Marcellini M, Devito R, Ciampalini P, Piemonte F, Comparcola D, et al. NAFLD in children: a prospective clinical-pathological study and effect of lifestyle advice. Hepatology 2006;44:458–465

    Article  PubMed  Google Scholar 

  81. Lavine JE. Vitamin E treatment of nonalcoholic steatohepatitis in children: a pilot study. J Pediatr 2000;136:734–738

    Article  CAS  PubMed  Google Scholar 

  82. Vajro P, Mandato C, Franzese A, Ciccimarra E, Lucariello S, Savoia M, et al. Vitamin E treatment in pediatric obesity-related liver disease: a randomized study. J Pediatr Gastroenterol Nutr 2004;38:48–55

    Article  CAS  PubMed  Google Scholar 

  83. Nobili V, Manco M, Devito R, Ciampalini P, Piemonte F, Marcellini M. Effect of vitamin E on aminotransferase levels and insulin resistance in children with non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2006;24:1553–1561

    Article  CAS  PubMed  Google Scholar 

  84. Vajro P, Franzese A, Valerio G, Iannucci MP, Aragione N. Lack of efficacy of ursodeoxycholic acid for the treatment of liver abnormalities in obese children. J Pediatr 2000;136:739–743

    Article  CAS  PubMed  Google Scholar 

  85. Schwimmer JB, Middleton MS, Deutsch R, Lavine JE. A phase 2 clinical trial of metformin as a treatment for non-diabetic paediatric non-alcoholic steatohepatitis. Aliment Pharmacol Ther 2005;21:871–879

    Article  CAS  PubMed  Google Scholar 

  86. Nadeau KJ, Ehlers LB, Zeitler PS, Love-Osborne K. Treatment of non-alcoholic fatty liver disease with metformin versus lifestyle intervention in insulin-resistant adolescents. Pediatr Diabetes 2009;10:5–13

    Article  CAS  PubMed  Google Scholar 

  87. Tock L, Prado WL, Caranti DA, Cristofalo DM, Lederman H, Fisberg M, et al. Nonalcoholic fatty liver disease decrease in obese adolescents after multidisciplinary therapy. Eur J Gastroenterol Hepatol 2006;18:1241–1245

    Article  PubMed  Google Scholar 

  88. Wang CL, Liang L, Fu JF, Zou CC, Hong F, Xue JZ, et al. Effect of lifestyle intervention on non-alcoholic fatty liver disease in Chinese obese children. World J Gastroenterol 2008;14:1598–1602

    Article  CAS  PubMed  Google Scholar 

  89. Reinehr T, Schmidt C, Toschke AM, Andler W. Lifestyle intervention in obese children with non-alcoholic fatty liver disease: 2-year follow-up study. Arch Dis Child 2009;94:437–442

    Article  CAS  PubMed  Google Scholar 

  90. Nobili V, Manco M, Ciampalini P, Alisi A, Devito R, Bugianesi E, et al. Metformin use in children with nonalcoholic fatty liver disease: an open-label, 24-month, observational pilot study. Clin Ther 2008;30:1168–1176

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium

    Ruth M. L. De Bruyne

  2. Paediatric Liver, GI and Nutrition Centre, King’s College London School of Medicine, King’s College Hospital, London, SE59RS, UK

    Emer Fitzpatrick & Anil Dhawan

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  1. Ruth M. L. De Bruyne
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Correspondence to Ruth M. L. De Bruyne.

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De Bruyne, R.M.L., Fitzpatrick, E. & Dhawan, A. Fatty liver disease in children: eat now pay later. Hepatol Int 4, 375–385 (2010). https://doi.org/10.1007/s12072-009-9160-z

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