Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children, affecting 1 in 10 children. According to the American Liver Foundation, the number of children affected by fatty liver disease is on the rise – having more than doubled in the last 20 years.
Millions of American children now experience this disease, and the rise in childhood obesity is one reason why says Charina Ramirez, M.D., a pediatric gastroenterologist at Children's Health℠ and Associate Professor at UT Southwestern. Dr. Ramirez specializes in the condition and explains its health risks and the importance of making lifestyle changes to reverse its damage.
What is non-alcoholic fatty liver disease?
Non-alcoholic fatty liver disease, also called fatty liver disease, is a condition in which fat builds up in the liver. If left untreated, it can lead to serious liver problems like fibrosis and cirrhosis (scarring of the liver) and liver cancer. There are two types of fatty liver disease:
- Simple fatty liver disease occurs when a child has excess fat (triglycerides) in the liver, but there is no inflammation or cell damage present.
- Non-alcoholic steatohepatitis disease (NASH) occurs when excess fat builds up in a child's liver and leads to inflammation and cell damage. If left untreated, the condition can scar the liver (fibrosis and cirrhosis) and increase a child's risk for developing liver failure or liver cancer as an adult.
What causes fatty liver disease in children?
It is caused when too much fat (triglycerides) builds up in the liver mainly because of poor eating habits and lack of physical activity. Fatty liver disease seems to develop in more boys than girls and can develop in children as young as 10 and even younger.
Risk factors for non-alcoholic fatty liver disease include:
- Insulin resistance
- Pre-diabetes or type 2 diabetes
- High cholesterol and high triglycerides
"The main reason fatty liver disease has become an epidemic is that more and more children face obesity. Children affected by obesity have a 38% chance of developing fatty liver disease," says Dr. Ramirez. "Since obesity is an epidemic on its own, fatty liver disease mirrors that."
Fatty liver disease may also have genetic factors and be inherited from parents. Hispanic families, in particular, may be at a higher risk for the condition. It is least common in African American children.
What are the dangers of a fatty liver?
Because fatty liver disease can lead to lifelong problems, early treatment is important. Over time, fatty liver disease can get worse and cause serious liver damage. However, fatty liver disease is considered a silent disease because it may not cause any symptoms. As the disease progresses, it can develop into non-alcoholic steatohepatitis (NASH).
"Unfortunately, NASH is now the number one reason for liver transplantation in women," says Dr. Ramirez. "In men, it's the second leading cause of transplantation behind alcoholic liver disease." Preventing the progression of the disease in children is critical.
One challenge of treating fatty liver disease is that it often shows no symptoms at all until serious scarring has occurred. If your child has risk factors for fatty liver disease, their pediatrician may screen them for the condition using a blood test, called ALT (alanine aminotransferase).
The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition recommends that children diagnosed with obesity be screened for the condition between the ages of 9 and 11. Children who are overweight and have a family history of the condition should also be screened. These screenings can help children and parents take steps to reverse the condition.
Can fatty liver disease be reversed?
There is no medication to reverse or cure fatty liver disease. However, lifestyle changes can make a big impact on disease progression in both the short- and long-term.
"While fatty liver disease is dangerous over the long-term, it is a disease you can work to improve," says Dr. Ramirez. "The liver is an interesting organ and capable of regenerating and recovering – if healthy lifestyle changes are made."
Children with fatty liver disease should work with a dietitian to develop a nutrition plan that involves fewer calories, less sugar and less fat. Children should also increase their physical activity.
"Studies show that kids are more responsive to weight management intervention when they are younger compared to when they are adults," says Dr. Ramirez. "But our true focus is not on weight loss for kids, but on lifestyle changes including healthy eating and routine physical activity."
Dr. Ramirez says that many kids have trouble maintaining a healthy weight because they don't understand how their favorite foods like chips, sodas and sports drinks are hurting their health and how vegetables can actually help them. Teaching kids about how these foods affect their livers gives them the tools they need to make better choices.
When it comes to exercise, children should be encouraged to do things they already love, whether that's basketball, soccer, dance, or walking or biking with the family.
"Fatty liver is the gateway to metabolic syndrome, including type 2 diabetes and eventually heart disease and hypertension," says Dr. Ramirez. "But you can make a positive impact on the risk of future chronic conditions by eating healthy and being active."
Non-alcoholic fatty liver disease in children is on the rise and a common risk factor is obesity. A pediatric gastroenterologist from @Childrens explains more on Fatty Liver Disease and what families need to know.
The Pediatric Liver Disease Program provides comprehensive treatment for pediatric liver disease, including the only pediatric liver transplant program in North Texas. Learn more about our liver program and services.