The effect of fructose on NAFLD in children and adolescents: a narrative review

Lipid infiltration in hepatic parenchyma cells leads to abnormal accumulation of lipids, usually in the form of triglycerides (either as a single large droplet or with multiple small droplets). The fatty liver caused by an imbalance in the metabolism of fatty acids.1 The nonalcoholic fatty liver disease is fatty liver (NAFLD) without excessive alcohol consumption.2 NAFLD includes a range of pathological conditions from simple steatosis to non-alcoholic steatohepatitis, fibrosis, cirrhosis and hepatocellular carcinoma. The prevalence of the disease in Europe and the US approaching 20-30%.1 It is now the most common form of the chronic liver disease in childhood and adolescence, affecting about 10-20% of the general pediatric population. In the next 10 years, NAFLD in pediatric patients is expected to become the most common cause of liver disease, hepatic insufficiency, and cause of liver transplantation in the western world.3 The liver is responsible for many metabolic and anabolic processes that take place in various anatomical compartments of the organ. Imbalance in fatty acid synthesis, beta-oxidation, and triglyceride accumulation lead to fat accumulation in hepatocytes. Accumulation of topic fat, mainly triglycerides, leads to simple steatosis. The most common cause of fatty liver can be attributed to increased caloric intake, which exceeds the caloric needs of the body. And while simple steatosis is considered to be a relatively benign liver disease, clinically it seems that 15-25% of patients could develop NAFLD. Also, some of the patients develop long-term fibrosis, cirrhosis or even hepatocellular carcinoma. Risk factors for the development of NAFLD are low physical activity, eating habits, intestinal microbial, genetic and regulatory factors and oxidative stress.1