Title: Non alcoholic fatty Liver Disease in Children and Adolescents with Type 1 Diabetes: Clinical, Diagnostic and Management Aspects

Biography:

Hoda Atwa is a professor of Pediatrics and head of endocrinology unit at a faculty of Medicine Suez Canal, Egypt.

Hoda's research interests include diabetes, obesity and child health. The prime focus of her work has been in patient-oriented studies in type 1 diabetes and related metabolic and vascular complications. She is the Principal Investigator of STDF- a funded project about genetics and environmental factors in children with T1D. The current research effort is focused on the relationship of heavy metals and diabetes, hypothyroidism and its effect on cognitive function. She is an editor and peer reviewer member in some medical journals. She has near one hundred of national and international publication.

She has served on the National Diabetes Advisory Board and on the National Board of DKA management guideline. She leads a multidisciplinary team that cares for more than 1000 children and adolescents with diabetes

Abstract

NAFLD is characterized by excessive hepatic fat accumulation. NAFLD includes two pathologically distinct conditions: non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH). The definition of nonalcoholic fatty liver disease (NAFLD) requires that there is evidence of hepatic steatosis and that there are no causes for secondary hepatic fat accumulation.

The prevalence of NAFLD varies by sensitivity of the diagnostics methods used and characteristics of population such as age, sex distribution, duration of diabetes, family history of T2D, BMI and degree of glycaemic control. NAFLD in T1D is characterized by an altered portosystemic gradient of insulin and lower degree of insulin resistance than T1D.

Although the majority of patients with NAFLD are asymptomatic, some may present with nonspecific symptoms. NAFLD remains a diagnosis of exclusion. Liver enzymes may not be elevated in all cases of NAFLD, and the level of aminotransferases does not reliably predict the extent of inflammation and cirrhosis. Hepatic MRI can give insight into the extent of liver involvement in NAFLD. Scores developed to predict steatosis are not accurate enough. Staging of hepatic fibrosis is the strongest predictor of disease-specific mortality. NAFLD has been associated with an increased prevalence of both micro- and macrovascular complications in patients with T1D.

The most commonly accepted goal of treatment is regression of NAFLD, defined as a decrease in steatosis, inflammation, and/or fibrosis. A second accepted goal is resolution of NASH. Medical nutrition therapy lifestyle modification is a safe and effective means of treating and preventing NAFLD. Pharmacological treatment may be required. No currently available medications have been proven to benefit the majority of children with NAFLD. A variety of new drugs are likely to emerge, permitting a more stage-based approach to NAFLD management.

Patients with simple fatty change had no increase in mortality, whereas patients with NASH had reduced survival and more cases died from cardiovascular disease than liver-related disease.