The American Academy of Pediatrics has endorsed new guidelines recommending the screening of all obese children aged 9 to 11 for non-alcoholic fatty liver disease (NAFLD)

The guidelines were developed by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), and also include recommendations for diagnosis, treatment, and follow-up care of children and adolescents with NAFLD. 

Some of the key recommendations include: 

• Screening: using a simple liver enzyme test (alanine aminotransferase, or ALT). 

• Diagnosis: Further tests are needed to determine a diagnosis, this may include obtaining a sample of liver tissue to check for more advanced disease.

• Treatment: There are no current medications proven to benefit NAFLD, thus improving diet and exercise are the first steps in treatment. Bariatric surgery may be considered for some with severe obesity.

• Long-term care: this includes managing cardiovascular risk factors, avoidance of liver toxins and being alert for possible psychosocial issues in children with NAFLD.

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The recommendations were made after comprehensive review by the NASPGHAN expert committee. Studies suggest that up to 38% of obese children and adolescents may have NAFLD, and the disease is known to have many related conditions, such as diabetes and sleep apnea. 

The committee demanded more high-quality studies of strategies for prevention, screening, diagnosis, and treatment of NAFLD in pediatric patients. 

The guidelines are published in full in the Journal of Pediatric Gastroenterology and Nutrition.

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