Did you know that fatty liver disease occurs in kids?
In the past, we thought that fatty liver disease occurred from alcohol abuse and only happened in adults.
Now we know better!
Plastic model of the inside of the human body showing the liver (brown organ).
We have a newer term - nonalcoholic fatty liver disease (NAFLD) - to distinguish it from alcohol causes. Now, there is an even newer term - MASLD (metabolic dysfunction-associated steatotic liver disease). I will use NAFLD for this article.
NAFLD is an increasing problem in children and the most common cause of chronic liver disease in this population. This is primarily due to the childhood obesity epidemic. The number of cases in children has been rising for the last two decades. Estimates show that 10-13% of children are affected by this, but in those with obesity, it is 40%. From 2009 to 2018, this rate increased by 62%!
These facts are frightening!
NAFLD is an increased amount of fat in the liver. These fat deposits can damage liver cells, resulting in liver inflammation and scarring. NASH (nonalcoholic steatohepatitis) is the more severe form of NAFLD, in which there is liver inflammation and damage. Most cases of NAFLD in children do not become NASH. In its most severe state, it can lead to cirrhosis and irreversible liver failure.
Having NAFLD puts a child at greater risk for
Type 2 diabetes
Metabolic syndrome
High blood pressure
High cholesterol and triglycerides
Heart disease
Progression to liver scarring and cancer
What are the symptoms?
Typically none! Unfortunately, this is a silent disease. Symptoms usually occur with advanced disease and include fatigue and pain in the belly under the rib cage on the right side.
What are the causes?
The following conditions put a child at risk for NAFLD and are more common if a child has NAFLD.
Obesity
Type 2 diabetes or insulin resistance
Metabolic syndrome
Elevated lipids (cholesterol and triglycerides)
High blood pressure
An unhealthy diet high in sugar
Sedentary lifestyle
Obstructive sleep apnea
It is more common in boys than girls and in those of Hispanic and Asian American descent.
How is it diagnosed?
There is no specific test for NAFLD, but it can be screened for by a blood test that checks liver enzymes. If these enzymes are high, an ultrasound of the liver might be done to look for excess fat or other problems. The only test that can definitively diagnose NAFLD is a liver biopsy.
Can NAFLD be treated?
Treatment is through weight loss, dietary changes, and exercise to reduce fat. Currently, there are no medications to treat this in children. If the liver becomes so damaged that it no longer functions, then a liver transplant is the treatment.
Can NAFLD be prevented?
Yes! Thumbs up sign with multiple hands to show that NAFLD is preventable.
The critical information is most cases of this liver disease are preventable. The following steps will help:
Serve portion sizes appropriate for your child’s age.
Reduce sugary beverage intake.
Encourage daily exercise of an hour a day.
Limit all forms of screen time.
Strive for 5 - five servings of fruit (not fruit juice) and vegetables daily.
Increase fiber intake with whole grains and legumes.
Limit fast food and ultra-processed food intake.
Decrease all sugar intake, especially high-fructose corn syrup, by reading labels.
Rather than frying foods, bake, broil, sauté, or grill.
10. If your child has risk factors, ask your doctor to check their liver enzymes.
Take steps now to reduce your child’s risk. Prevention is the best medicine.
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