Fatty liver disease … even the name is unsettling. But those three little words gradually are taking hold in vocabularies of more parents, dietitians and pediatricians.
So what is this condition with the odd-sounding name?
“In plain terms, it’s a buildup of fat in the liver,” explains Dr. Stephanie Abrams, a hepatologist with Texas Children’s Liver Center. “While everyone’s liver is supposed to have some fat, doctors diagnose the condition once fat exceeds safe levels, which is about 10 percent of the organ’s weight.”
Until recently, fatty liver disease rarely afflicted anyone but adults, most of them diabetic, overweight or malnourished (or, for one form of the disease, heavy or frequent drinkers of alcohol).
But as part of this country’s worrisome trend of obesity, fatty liver disease now manifests more frequently across the population. It’s even showing up in teens and in children, many times as a “side effect” of being obese or extremely overweight. “It was recently reported that 13 percent of all children have fatty liver disease,” says Abrams.
In most cases, it causes no problems. Displaying no symptoms as it develops over years, fatty liver is usually found during diagnostics done for other purposes. “Most fatty liver disease in children is diagnosed when pediatricians conduct standard medical tests to look for co-morbidities in obese children,” explains Abrams.
Many afflicted children have no reason to suspect their livers are compromised until advanced cases produce hard-to-pin-down feelings of fatigue, weight loss, weakness and abdominal pain.
“Over time, fatty liver disease might lead to liver inflammation called steatohepatitis,” says Abrams. “Nonalcoholic steatohepatitis – or NASH – is a cause of cirrhosis, which is hardening and scarring of the liver.”
Abrams, also an assistant professor of pediatrics at Baylor College of Medicine, explains that a liver damaged beyond healing cannot keep up with the digestion, purification and protein-making functions the body depends on. Some patients with NASH may need liver transplants.
To reach the diagnosis, doctors first rule out other disease through blood tests, an ultrasound and CT scan or MRI. Definitive diagnosis comes from biopsy, which involves removal of a tiny amount of tissue through a needle.
Treatment recommendations are nearly the same for children and adults.
“Lifestyle changes can minimize further trouble and sometimes even reverse liver damage already done by the condition, but there’s no magic pill or quick fix,” says Abrams. “Losing weight will improve the condition; in fact, some 90 percent of patients with improvement in their liver disease have lost weight.”
Other treatment options include treating high triglycerides or diabetes – if present. “If these illnesses are not present in a patient who has fatty liver, then the standard of care is to enroll in a clinical trial,” says Abrams.
Diabetic and overweight patients, or those with high blood lipids (high blood fats, in other words) will be put on low-fat, low-calorie diets, and sometimes prescribed insulin and other diabetes medications.
Even children and adults not diabetic or overweight will probably be prescribed low-fat diets, along with other healthy eating habits and adequate exercise. With compromised livers, people of all ages need to avoid alcohol.
On the research horizon, scientists are developing new medicines aimed at reducing liver inflammation. Other experimental medicines under development to control diabetes show promise in helping reduce liver disease in non-diabetics, too.
Texas Children's Hospital currently is participating in a National Institutes of Health-funded clinical trial called T.O.N.I.C., or Treatment of Nonalcoholic Fatty Liver Disease In Children—that is testing the effectiveness of metformin and vitamin E as potential treatment options for NASH.
So how can parents protect their children?
“A healthy lifestyle is the best weapon against fatty liver disease – and everyone’s first building block of general health,” says Abrams.
