Which Method is Superior in the Diagnosis of Nonalcoholic Fatty Liver and Steatohepatatis in Children

Context: Nonalcoholic fatty liver disease (NAFLD) is increasing with the increased rate of obesity and reduced physical activity in children worldwide. Despite high prevalence of the disease, a standard and acceptable diagnostic method is not available. The current study aimed at collecting all related articles and evaluating the challenges. Methods: The current study searched Scopus, Web of Science, and PubMed. Articles and guidelines in English in the field of invasive and noninvasive diagnostic methods for NAFLD and nonalcoholic steatohepatitis (NASH) in children and adolescents up to Oct 2016 were used. It was tried to evaluate all laboratory and radiologic methods, biomarkers, and scores in addition to mention the challenges. Results: Ultrasonography and laboratory evaluation, which were routine methods in early diagnosis, did not have enough accuracy in this field. Diagnosis of steatosis and fibrosis and determining the severity of disease were achieved by fibro scan and controlled attenuation parameter (CAP) without the challenges of computed tomography (CT) scan and magnetic resonance imaging (MRI). Fatty liver can be predicted with high accuracy by body analyzer, anthropometric, and DEXA methods. Conclusions: Diagnosis and prediction of fatty liver should be done in all children with obesity aged > 3 years, and physician should seek the genetic and metabolic causes in children aged < 3 years and/or without overweight.