Non-alcoholic fatty liver disease in the practice of a primary care pediatrician

Background. Non-alcoholic fatty liver disease is one of the main multidisciplinary problems in pediatrics. Approximately one in 3-4 people in the population has non-alcoholic fatty liver disease. The overall incidence of the disease in children is 9%, and in overweight and obese children it reaches 40%. The growth of this pathology is associated with an increase in the number of patients suffering from overweight, obesity, type 1 and type 2 diabetes mellitus and a condition such as insulin resistance. An important pathogenetic factor is a violation of intestinal permeability with bacterial translocation and a change in the composition of the intestinal microbiota. Disruption of the gut-liver axis in the pathogenesis of non-alcoholic fatty liver disease requires mandatory inclusion of strain-specific probiotics in the treatment program.

Objective. To conduct a literary review of modern domestic and foreign literature on the early diagnosis of non-alcoholic fatty liver disease, to substantiate patient management tactics using the example of a clinical case.

Materials and methods. Modern literature on the problem of non-alcoholic fatty liver disease has been studied, general scientific methods have been applied: analytical, scientific and organizational.

Results. Modern research denies the benign course of this disease. It has been proven that non-alcoholic fatty liver disease can lead to fibrous changes in the liver parenchyma and in the future, in the absence of early treatment, to its cirrhosis. Therefore, early diagnosis and comprehensive treatment of non-alcoholic fatty liver disease in children is an interdisciplinary task. The diagnosis of non-alcoholic fatty liver disease in children consists in the use of non-invasive methods: biochemical tests, ultrasound diagnostics (ultrasound), elastography, magnetic resonance imaging and computed tomography.

Conclusion. Early diagnosis and initiation of treatment are especially important in childhood, since the disease during this period of life is characterized by reversible structural and functional changes. The most promising drugs are those that affect the main targets of the disease: inflammation, liver fibrogenesis, correction of insulin resistance, correction of the intestinal microbiota, as well as the organization of a rational diet, daily routine and physical activity.

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