nonalcoholic fatty liver disease treatment

nonalcoholic fatty liver disease (nafld) is increasing in pediatric age group parallel to the growing prevalence of obesity and overweight all around the world. so changing in life style and   interventions on obesogenic environment is cornerstone of nafld therapy in obese children. some experts recommend that children and adolescents be encouraged to follow a low-fat, low-glycemic-index diet that includes eating a minimum of 5 servings of vegetables and fruits daily, engaging in physical activity for at least 1 hour daily, and minimizing television/computer time to 2 hours daily.  in spite of effectiveness of weight loss and exercise in improvement nafld, this goal is very difficult to be achieved and pharmacological approaches have become necessary. pharmacologic therapies against one or more specific factors and/or molecules involved in the development of nafld (i.e., insulin resistance, free fatty acid lipid toxicity, and oxidative stress) also might slow the progression of nafld to nash or cirrhosis.  on this basis, insulin sensitizers, antioxidants, cytoprotective agents, and dietary supplementations have been evaluated in pediatric clinical trials but there is no approved pharmacologic therapy for nafld or nash. not all obese children affected by nafld. diet modification and regular exercise beside to serial medical follow up highly suggested for this group of children. normal weight and thin children with nafld or nash should be investigated appropriately in a logical manner based on causes of primary liver steatosis in children and treatment of underlying disease can cause improvement fatty liver in these patients.   keywords: non-alcoholic fatty liver disease; non-alcoholic steatohepatitis; children; steatosis; treatment