Fatty liver in children and adolescents

A few weeks ago, a chubby 14-year-old teenager was referred to our clinic due to a mildly elevated blood pressure. We did some blood tests and the liver enzymes were found to be elevated. He has no history of any liver problem like hepatitis in the past; he swore he has never tasted any alcohol preparation, and I believed him. We did an ultrasound to check on the liver and it showed an extensive fatty liver.

We couldn’t help but ask: How many of our young people already have fatty liver, which can remain undetected for many years, until it progresses into something much worse already like cirrhosis of the liver?

As the term implies, fatty liver consists of a collection of high amounts of fat around the liver. There are two types: alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD). The first type is due to an excessive consumption of alcohol, while the second one develops in non-drinkers, usually associated with an unhealthy diet, diabetes, cholesterol problems and obesity.

Simple fatty liver, also called steatosis, is due to the deposition of fats in the liver. There is no liver inflammation or scar tissue formation yet. And the risk of progressive liver damage is relatively low. Usually, individuals with simple fatty liver are symptomless.

Swelling

If the risk factors causing the fatty liver are not controlled, it can progress into a non-alcoholic steatohepatitis (NASH), wherein inflammation or swelling of the liver cells are present already. If the swelling persists, this can cause some liver cells to die; and if this becomes extensive as what happens in a few, it may lead to liver cirrhosis, characterized by extensive liver scarring.

I remember when I was in residency training in internal medicine, NAFLD was regarded as a benign condition, likely just a concomitant finding of being overweight, or being a diabetic.  But published studies over the last 12 years now strongly consider NAFLD as a disease entity by itself,  which can have  serious consequences in the future if neglected.

Of course, the progression to a severe form may take many years, perhaps decades. But if one has already fatty liver at a young age, he or she would still be relatively young after three to four decades. And since the risk factors for fatty liver are the same risk factors that cause heart disease, metabolic syndrome and other diseases, the picture becomes more complicated.

The following risk factors have been implicated, which are all present in the adolescent patient we saw recently: unhealthy eating habits like eating high-fat concentrated, fried foods rich in bad cholesterol, “fast foods,” sugar-rich snacks; lack of physical activity or sedentary life; and being overweight or obese.

Fatty liver is now truly becoming highly prevalent even in children and adolescents with the so-called modern diet and modern lifestyle we have today. For the more adventurous teenagers and young adults, a fat-rich diet coupled with alcohol drinking significantly increase their risk of developing fatty liver.

Healthy eating, regular exercise, and drinking in moderation—or better yet, complete avoidance—are simple ways to prevent a fatty liver disease, and if practiced at an early age, can go a long way in preventing fatty liver. Our schools should inculcate this in our youth’s mind, as part of the curriculum.

Increasing prevalence

With the increasing prevalence of obesity in our children and young adults, the risk of developing fatty liver has remarkably increased too. In 2008, obesity has ballooned to 25 percent from 1987 statistics of only 13.5 percent. Type 2 diabetes mellitus, not the insulin-dependent type, has also been increasingly reported in obese children and adolescents.

Not all cases of fatty liver will have a sad ending. But if it’s a loved one who has it, we don’t want to take any chance of it developing into something much worse than just fatty liver. So we need to teach our kids at an early age to practice healthy lifestyle and good eating habits by avoiding fatty foods like junk foods and French fries. Adults should also show them the example on “responsible drinking,” but at their age, they should be encouraged to lay their hands off the alcohol bottle.

Chubby kids may look cute and healthy, but not if they already have some “precursor diseases” like prediabetes, prehypertension and fatty liver. By allowing them to get used to an unhealthy diet and lifestyle, we may be unwittingly compromising the health and lives of these children and adolescents. Let’s take pity on these young souls.