Die nicht-alkoholische Fettlebererkrankung bei Kindern und Jugendlichen – ein Update

Zusammenfassung

Die nicht-alkoholische Fettlebererkrankung (NAFLD) ist die häufigste chronische Lebererkrankung im Kindes- und Jugendalter und eng mit Übergewicht und Adipositas assoziiert. Es kommt zur Fetteinlagerung in die Hepatozyten – teilweise mit Inflammation, welche den fibrotischen und zirrhotischen Umbau des Lebergewebes zur Folge haben kann. Die Ursachen sind nicht vollständig geklärt; als Risikofaktoren gelten hyperkalorische Ernährung, Übergewicht, Insulinresistenz und genetische Determinanten. Betroffene zeigen meist keine Symptome und fallen erst durch erhöhte Leberwerte auf. Dann sollte eine Kontrolle und gegebenenfalls eine erweiterte differenzialdiagnostische Abklärung erfolgen. Zur Diagnosesicherung bedarf es einer Leberbiopsie. Als vielversprechende nicht-invasive Alternativen werden bisher bildgebende Verfahren, klinische Scores und Serummarker weiter validiert. Die Therapie der NAFLD besteht aus einer Lifestyle-Modifikation mit regelmäßiger Bewegung und einer ausgewogenen, fruktosearmen Ernährung. Gelingt es Patienten, Gewicht zu verlieren, ist die Prognose gut, und fibrotische Veränderungen sind potenziell reversibel. Kommt es hingegen zu einer weiteren Gewichtszunahme schreitet die Erkrankung fort und kann in einem Leberversagen enden. Eine frühzeitige Diagnose und Therapieeinleitung sind daher essenziell.

Abstract

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children and adolescents and is associated with obesity. This disease presents either as simple steatosis which is characterized by fat accumulation in the hepatocytes or non-alcoholic steatohepatitis which additionally shows inflammation and can lead to liver fibrosis or even cirrhosis. The pathogenesis is not fully understood, but risk factors include hypercaloric diet, obesity, insulin resistance and genetic. Affected patients usually do not show any symptoms, but can be identified by elevated liver enzymes. If that is the case, a control and if necessary an extended differential diagnosis should follow. A liver biobsy is required for verification. As promising non-invasive alternatives, new imaging techniques, clinical scores and novel biomarkers need further validation. The therapy of NAFLD is based on lifestyle modifications, with an increase of physical activity and a balanced, low-fructose diet. If patients are successful losing weight, the prognosis is good and fibrotic changes are potentially reversible. If patients gain more weight, a disease progress is expected and can result in a liver cirrhosis. Therefore an early diagnosis and an initiation of the appropriate treatment is essential.

Schlüsselwörter

Metabolisches Syndrom - Adipositas - pädiatrische NAFLD - Übersicht

Key words

Metabolic Syndrome - Obesity - pediatric NAFLD - review

Publikationsverlauf

Artikel online veröffentlicht:
14. Mai 2020

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