Non-alcoholic fatty liver disease (NAFLD) is an increasing health threat in obese children and adolescents, which represents a wide spectrum of liver conditions, ranging from asymptomatic steatosis to steatohepatitis. This increase in fatty liver disease in children will contribute to a further increased risk of metabolic and cardiovascular complications. 

Metabolic Syndrome (MetS) may show hepatic manifestation in the form of NAFLD, which have been proved with much evidence demonstrating children with NAFLD presenting one or more features of MetS. But the pathogenetic mechanisms of the interrelationships between fatty liver disease and MetS are unclear. The core pathophysiology in both the diseases may be attributed to central obesity and insulin resistance, interestingly; genetic susceptibility and environmental triggers are reported as crucial components for causing NAFLD and MetS in children.

Dyslipidemia, a crucial diagnostic criterion of MetS, also shows a close association between impaired lipid profile and NAFLD in children and adolescents. It is also an emerging risk factor in the development of cardiovascular diseases and metabolic disorders.

The mainstay of NAFLD therapy remains lifestyle interventions on the obesogenic environment and sedentary life, to reduce obesity-related hepatic and metabolic abnormalities. But it is often difficult to achieve and the results not always being satisfactory. Since now, there are newly identified potential pathogenetic triggers for this disease; novel pharmacologic therapies have been proposed. This includes the use of probiotics which is a remarkable and reasonable approach due to their safety and acceptability.

Thus children and adolescents with NAFLD must be screened for MetS and vice-versa. Understanding the natural history and etiology of NAFLD to identify early prevention strategies and efficient therapeutic approaches to improve the quality of life of these children remains the need of the time.

Source- DAdamo E, Castorani V, Nobili V. The Liver in Children With Metabolic Syndrome. Front. Endocrinol. 2019;10:514. doi: 10.3389/fendo.2019.00514