Nonalcoholic fatty liver disease in children

Nonalcoholic fatty liver disease, excess buildup of fat in the liver (specifically in people who don't regularly drink or abuse alcohol), doesn't only affect adults. It happens to be the leading cause of chronic liver disease in children.

A possible precursor to serious liver problems that can develop in early adulthood such as cirrhosis and liver cancer, nonalcoholic fatty liver disease is associated with a number of risk factors, but primarily pediatric obesity.

"The most accurate studies show that the prevalence is somewhere between 7 and 9 percent among all children in the United States. If you're obese, the prevalence rate goes up to 32 percent," says Sana Mansoor, M.D., a board-certified LifeBridge Health pediatric gastroenterologist.

The types

Simple fatty liver (steatosis) is a form of nonalcoholic fatty liver disease in which a child has abnormal fat buildup in the liver, but there's no cell damage or inflammation. If left untreated, simple fatty liver can progress to nonalcoholic steatohepatitis.

A more serious form of nonalcoholic fatty liver disease, nonalcoholic steatohepatitis (NASH) is a condition in which a child has inflammation of the liver (hepatitis) and cell damage, which can lead to scarring of the liver (otherwise known as fibrosis). Severe scarring could lead to cirrhosis or liver cancer.

The risk factors

In addition to pediatric obesity, nonalcoholic fatty liver disease is linked to diabetes (and pre-diabetes), insulin resistance, high blood pressure, and elevated blood lipids (high cholesterol and triglycerides). Family history factors into a child's risk of developing this condition. But by far, Mansoor says, obese children with metabolic syndrome (a cluster of conditions including high blood pressure, high blood sugar and excess body fat) are at the greatest risk.

It typically goes unnoticed

Often, Mansoor says, nonalcoholic fatty liver disease doesn't present any signs or symptoms. "It can go missed for several years," she says.

Some children may complain of abdominal pain. Other possible symptoms include:

• Fatigue
• Loss of appetite
• Weight loss
• Nausea
• Mental confusion
• Nonspecific abdominal discomfort or pain

How it is diagnosed

Because there are no obvious symptoms associated with nonalcoholic fatty liver disease, it's important that parents make sure children get yearly check-ups that include an assessment of lifestyle factors and the child's body mass index (BMI). It is recommended that obese children ages 9 to 11 be screened for nonalcoholic fatty liver disease. Screening should also be done in overweight children with risk factors such as family history and signs of insulin resistance.

"There are studies that have shown that it can develop in kids as young as two years of age," Mansoor says. "The process of fat deposition can start happening when you're very, very young."

Blood and imaging tests, as well as liver biopsies, are done to diagnose nonalcoholic fatty liver disease and examine the extent of other liver problems.

How it's treated

Different things like vitamin E, metformin and fish oil have been studied as possible remedies for nonalcoholic fatty liver disease. What's been proven to work, Mansoor says, is old-fashioned diet and exercise.

"It has been shown that if you reduce your weight by 10 percent of your bodyweight, the fatty liver improves by 90 percent," Mansoor says. "So the only treatment that we know works is lifestyle intervention."

She adds: "Because we know that this condition can progress to cirrhosis in our kids, there is a recommendation now that if a child has a BMI of more than 35, bariatric surgery should be considered as a treatment option."

A good, balanced diet with plenty of fruits and vegetables and reduced saturated fat and sugar is ideal for children. Other things parents can do to improve their child's diet:

• Limit foods with sugars and/or "hidden" fat (pastries, pies, chips, biscuits, etc.)
• Grill, bake, boil or steam foods rather than fry them
• Avoid adding fats and sugars to foods
• Remove all visible fat from meats (and skin and fat from chicken)
• Choose sugar-free or reduced sugar items

Nonalcoholic fatty liver disease is a condition treated by LifeBridge Health pediatricians. Call 410-601-WELL to learn more about services offered at LifeBridge Health or to schedule an appointment with a physician.