Feature Article| Volume 14, ISSUE 10, P725-731, November 2018

Nonalcoholic Fatty Liver Disease in Children: Beyond Metabolic Syndrome

Published:October 26, 2018DOI:


      • Nonalcoholic fatty liver disease (NAFLD) is the number one cause of liver disease in children and adolescents in the US.
      • NAFLD is related to obesity and may present with cardiovascular and metabolic risks.
      • Recognition and management of children with NAFLD begins in the primary care setting.


      Nonalcoholic fatty liver disease (NAFLD) has been identified as the number one cause of liver disease in children and adolescents in the United States. This increasing rate of liver disease is directly related to obesity. Often the initial presentation of NAFLD is a child or adolescent with increased risk of cardiovascular and/or metabolic risk factors. According to the United Network of Organ Sharing, NAFLD is rapidly becoming the leading cause of chronic liver disease and liver transplants in older children. It is important for pediatric primary care providers to recognize the risk factors for NAFLD and provide a coordinated, multidisciplinary approach for interventions to prevent and limit liver disease in children and adolescents.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Vos M.
        • Abrams S.
        • Barlow S.
        • et al.
        NASPGHAN clinical practice guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children: recommendations from the expert committee on NAFLD and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN).
        J Pediatr Gastroenterol Nutr. 2017; 64: 319-334
        • Temple J.L.
        • Cordero P.
        A guide to non-alcoholic fatty liver disease in childhood and adolescence.
        Int J Mol Sci. 2016; 17: E947
        • Children’s Liver Disease Foundation
        Non-alcoholic fatty liver disease (NALFD): a guide.
        (Accessed April 6, 2018)
        • Balistreri W.
        Liver diseases in children: challenges and opportunities, 2015.
        (Accessed March 10, 2018)
        • Anderson E.L.
        • Howe L.D.
        The prevalence of non-alcoholic fatty liver disease in children and adolescents: a systematic review and meta-analysis.
        PLoS One. 2015; 10: e0140908
        • Fusillo S.
        • Rudolph B.
        Nonalcoholic fatty liver disease.
        Pediatr Rev. 2015; 36: 198-205
        • Clemente M.G.
        • Madato C.
        Pediatric non-alcoholic fatty liver disease: recent solutions, unresolved issues, and future research directions.
        World J Gastroenterol. 2016; 22: 8078-8093
        • Woo Baidal J.A.
        • Elbel E.E.
        • Lavine J.E.
        • et al.
        Associations of early to mid-childhood adiposity with elevated mid-childhood alanine aminotransferase levels in the Project Viva cohort.
        J Pediatr. 2018; 197: 121-127
        • Schwimmer J.B.
        • Deutsch R.
        Prevalence of fatty liver in children and adolescents.
        Pediatrics. 2006; 118: 1388-1393
        • Hagstrom H.
        • Stal P.
        Overweight in late adolescence predicts the development of severe liver disease later in life: a 39 years follow-up study.
        J Hepatol. 2016; 65: 363-368
      1. Centers for Disease Control. Accessed March 10, 2018.

        • Mrad R.A.
        • Merjaneh N.
        The increasing burden of nonalcoholic fatty liver disease among young adults in the United States: a growing epidemic (letter to the editor).
        Hepatology. 2016; 64: 1386-1387
        • Oddy W.H.
        • Herbison C.E.
        • Jacoby E.
        • et al.
        The western dietary pattern is prospectively associated with nonalcoholic fatty liver disease in adolescence.
        Am J Gastroenterol. 2013; 108: 778-785
        • Mosca A.
        • Vania A.
        Kids, food, and fatty livers: fructose vs the med diet.
        (Accessed March 10, 2018)
        • Mollard R.C.
        • Senechal M.
        • MacIntosh A.C.
        • et al.
        Dietary determinants of hepatic steatosis and visceral adiposity in overweight and obese youth at risk of type 2 diabetes.
        Am J Clin Nutr. 2014; 99: 804-812
        • Singer C.
        • Stancu P.
        Non-alcoholic fatty liver disease in children.
        Curr Health Sci J. 2014; 40 (Accessed March 15, 2018): 170-176
      2. American Academy of Pediatrics announces new recommendations for children’s media use. American Academy of Pediatrics. October 31, 2016. Accessed August 1, 2018.

        • Balistrieri W.
        • Xanthakos S.
        The hidden epidemic of liver disease in kids. 2013.
        (Accessed March 10, 2018)
        • United Network for Organ Sharing
        National data 2017.
        (Accessed March 15, 2018)


      Stacia M. Hays, DNP, CPNP-PC is Clinical Assistant Professor, University of Florida College of Nursing, Gainesville,FL. She is available at .


      Cheryl W. McGinnis, DNP, ANP-BC, Certified Clinical Transplant Coordinator. DNP Program Coordinator, Walden University, Minneapolis, MN.