Schwimmer et al identified patterns of histopathologic change in pediatric patients with nonalcoholic fatty liver disease (NAFLD). The type of NAFLD may impact how the disease progresses in the individual patient. The authors are frm the University of California San Diego and Rady Children's Hospital in San Diego.



(1) simple steatosis

(2) nonalcoholic steatohepatitis (NASH) Type 1

(3) nonalcoholic steatohepatitis Type 2


All 3 show steatosis. The severity of the steatosis may be affected by a number of factors especially recent exposures or the lack thereof. It is possible for features of NASH Type 1 or Type 2 to be present with no steatosis.


Features of NASH Type 1 - one or both of the following:

(1) ballooning of hepatocytes

(2) perisinusoidal fibrosis


Features of NASH Type 2 - one or both of the following:

(1) increased portal inflammation

(2) portal fibrosis


NASH Type 1 was more common in White children while Type 2 was common in Asian, Hispanic and Native American children.


As the disease progresses the condition enters a fibrotic phase with eventual progression to cirrhosis.


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