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Introdução: A Doença Hepática Gordurosa Não Alcoólica (NAFLD) constitui a principal
patologia hepática crónica na faixa pediátrica a nível mundial, à semelhança do que se
verifica na população adulta, em decorrência da epidemia global da obesidade. Considerada
a manifestação hepática da síndrome metabólica, consiste num espectro de patologias que
varia de esteatose simples a esteatohepatite (NASH), com potencial progressão para cirrose,
insuficiência hepática e carcinoma hepatocelular, mas apresenta igualmente repercussões
sistémicas. A importância da deteção atempada de NAFLD tem fomentado a pesquisa, nos
últimos anos, de ferramentas não invasivas de diagnóstico que possam ser mais apelativas
para as crianças face à biópsia hepática, o método padrão-ouro, invasivo, não desprovido
de complicações e com critérios específicos de aplicação. Relativamente ao tratamento, as
medidas de alteração do estilo de vida constituem a primeira linha, mas tem aumentado a
pesquisa de medidas farmacológicas que possam complementar as primeiras.
Objetivos: O objetivo desta revisão bibliográfica é a abordagem do atual estado da arte
relativo à NAFLD Pediátrica, no que concerne aos dados epidemiológicos, mecanismos de
etiologia e patogénese, apresentação clínica, diagnóstico e tratamento.
Materiais e métodos: A presente monografia foi realizada através da pesquisa
bibliográfica de artigos científicos na base de dados «PubMed/MEDLINE», a partir das
palavras-chave «NAFLD», «children», «etiopathogenesis», «diagnosis» e «treatment»,
com limitação do período temporal aos últimos 10 anos. Foram selecionados artigos de
revisão, diretrizes e ensaios clínicos (preferencialmente randomizados), redigidos em
inglês, e constituíram critérios de exclusão artigos prévios ao intervalo temporal referido,
redigidos em outros idiomas, assim como estudos pré-clínicos, fundamentados em modelos
animais e celulares.
Resultados: A informação contemplada nos artigos selecionados permitiu a compreensão
de que a pesquisa acerca desta temática se tem revelado profícua, mas que muita da
evidência relativa a ferramentas não invasivas de diagnóstico e ao tratamento ainda não é
passível de ser aplicada na prática clínica, por ausência de validação, sendo necessários mais
estudos.
Conclusão: É importante que, futuramente, continue a pesquisa relativamente à origem
da NAFLD Pediátrica, às ferramentas não invasivas de diagnóstico e às potenciais opções
terapêuticas. Idealmente, deverão ser realizados mais ensaios clínicos, com amostras
maiores e durante um intervalo temporal mais prolongado, de modo que os resultados obtidos sejam mais precisos e passíveis de constituírem evidência sólida. Relativamente à
história natural, não completamente elucidada, devem ser efetuados mais estudos coorte
retrospetivos que acompanhem as crianças e os adolescentes por longos períodos, para que
se possa compreender mais claramente as consequências a longo prazo e a extensão em que
estas ocorrem.
Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) is the main chronic liver disease in the pediatric population worldwide, similarly to what happens in the adult population, due to the global epidemic of obesity. Considered the hepatic manifestation of the metabolic syndrome, it consists of a spectrum of pathologies that ranges from simple steatosis to steatohepatitis (NASH), with potential progression to cirrhosis, liver failure and hepatocellular carcinoma, but has also systemic repercussions. The importance of a timely detection of NAFLD has encouraged research, in recent years, for non-invasive diagnostic tools that may be more indicated for children compared to liver biopsy, the gold-standard, invasive method, not devoid of complications and with specific criteria for application. Regarding treatment, measures to change lifestyle are the first line, but the search for pharmacological measures that can complement the first has increased. Objectives: The aim of this bibliographic review is to address the current state of the art concerning Pediatric NAFLD, in terms of epidemiological data, mechanisms of etiology and pathogenesis, clinical presentation, diagnosis and treatment. Methodology: This monograph was carried out through a bibliographic search of scientific articles in the «PubMed/MEDLINE» database, using the keywords «NAFLD», «children», «etiopathogenesis», «diagnosis» and «treatment», published within the last 10 years. Review articles and clinical trials (preferably randomized) written in English were selected. Articles prior to the mentioned time interval, written in other languages, as well as pre-clinical studies based on animal and cellular models were exclusion criteria. Results: The information included in the selected articles allowed us to understand that research on this topic has proved to be fruitful, but that much of the evidence relating to non-invasive diagnostic tools and treatment is still not capable of being applied in clinical practice, for lack of validation, requiring further studies. Conclusion: It is important that, in the future, research continues regarding the origin of Pediatric NAFLD, non-invasive diagnostic tools and potential therapeutic options. Ideally, more clinical trials should be carried out, with larger samples and over a longer period of time, so that the results obtained are more accurate and likely to constitute solid evidence. Regarding the natural history, which is not fully elucidated, further retrospective cohort studies should be carried out that follow children and adolescents for long periods, so that the long-term consequences and the extent to which they occur can be more clearly understood.
Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) is the main chronic liver disease in the pediatric population worldwide, similarly to what happens in the adult population, due to the global epidemic of obesity. Considered the hepatic manifestation of the metabolic syndrome, it consists of a spectrum of pathologies that ranges from simple steatosis to steatohepatitis (NASH), with potential progression to cirrhosis, liver failure and hepatocellular carcinoma, but has also systemic repercussions. The importance of a timely detection of NAFLD has encouraged research, in recent years, for non-invasive diagnostic tools that may be more indicated for children compared to liver biopsy, the gold-standard, invasive method, not devoid of complications and with specific criteria for application. Regarding treatment, measures to change lifestyle are the first line, but the search for pharmacological measures that can complement the first has increased. Objectives: The aim of this bibliographic review is to address the current state of the art concerning Pediatric NAFLD, in terms of epidemiological data, mechanisms of etiology and pathogenesis, clinical presentation, diagnosis and treatment. Methodology: This monograph was carried out through a bibliographic search of scientific articles in the «PubMed/MEDLINE» database, using the keywords «NAFLD», «children», «etiopathogenesis», «diagnosis» and «treatment», published within the last 10 years. Review articles and clinical trials (preferably randomized) written in English were selected. Articles prior to the mentioned time interval, written in other languages, as well as pre-clinical studies based on animal and cellular models were exclusion criteria. Results: The information included in the selected articles allowed us to understand that research on this topic has proved to be fruitful, but that much of the evidence relating to non-invasive diagnostic tools and treatment is still not capable of being applied in clinical practice, for lack of validation, requiring further studies. Conclusion: It is important that, in the future, research continues regarding the origin of Pediatric NAFLD, non-invasive diagnostic tools and potential therapeutic options. Ideally, more clinical trials should be carried out, with larger samples and over a longer period of time, so that the results obtained are more accurate and likely to constitute solid evidence. Regarding the natural history, which is not fully elucidated, further retrospective cohort studies should be carried out that follow children and adolescents for long periods, so that the long-term consequences and the extent to which they occur can be more clearly understood.
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Keywords
Crianças Diagnóstico Etiopatogénese Nafld Tratamento