Letter to the editor in response to: A case of pediatric alcohol‐associated hepatitis evaluated for liver transplant listing

Le résumé fourni par la source

We are writing in response to the report by Schenker et al. detailing a 15-year-old male with end-stage liver disease, focusing on the rare occurrence of alcohol-associated liver disease (ALD) in teenagers.1 However, an important aspect of the patient's medical history was overlooked. Three years before the development of end-stage liver disease, the patient was diagnosed with type 2 diabetes and severe obesity. Notably, 25% of children with obesity have nonalcoholic fatty liver disease (NAFLD).2 Among children with NAFLD, those with type 2 diabetes have a three-fold higher likelihood of having nonalcoholic steatohepatitis (NASH) and potential fibrosis.3 Hence, it is probable that the child had NASH with fibrosis at age 12. Importantly, NAFLD and ALD can coexist, with alcohol accelerating fibrosis in NAFLD.4 Although these conditions share overlapping features, a proper diagnosis of NASH is crucial to inform prognosis. Confirming the presence of NASH becomes particularly important for optimizing post-transplant management, considering the high recurrence rate of NASH.5 In conclusion, the case report effectively highlights the dire consequences of alcohol abuse in young individuals. However, it is vital to acknowledge the likelihood of pre-existing NAFLD. Early diagnosis, monitoring, and intervention are pivotal in preventing the worsening of liver disease and associated complications.6 By promptly identifying liver disease in adolescents with obesity and comorbid conditions like diabetes, physicians can intervene before alcohol abuse accelerates disease progression. Let us strive for comprehensive care and education for at-risk adolescents, securing a healthier future for generations to come. The authors declare no conflict of interest.

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