Liver Disease in Children Rises with Obesity
Researchers are taking a closer look at a previously rare disease that is now on the rise as obesity in children increases. Non-Alcoholic Steatohepatitis (NASH), more commonly known as Fatty Liver Disease, occurs in approximately 15% of obese children.
Fatty Liver Disease (FLD) is when excess fat accumulates in the liver. While not life threatening by itself, it can lead to cirrhosis of the liver over time, sometimes requiring transplantation by adulthood. Today, the most common causes of cirrhosis requiring transplantation are chronic alcoholism and hepatitis. Within one generation, FLD secondary to obesity is expected to move to the top of the list, surpassing both alcoholism and hepatitis.
Approximately one third of children and teens in the United States are overweight, and 15% of children and teens are obese. Estimates indicate that FLD may exist in 15% or more of obese children, or one out of every 40 children. Children are routinely tested for conditions that have a much lower incidence, such as scoliosis, due to the severe physical and social implications. Despite its dramatically increasing incidence, and the huge potential impact on society, there are no guidelines to screen for liver disease in children.
The American Liver Foundation currently estimates that 10-20% of Americans have Fatty Liver Disease. This means that there are currently between 30 to 60 million overweight Americans with ongoing damage to their livers as a result of excess weight. The huge concern is that many of these people will progress to cirrhosis and eventual liver failure.
Until now, the treatment for Fatty Liver Disease has been to offer dietary and exercise counseling, but this is often not effective. Only a significant and maintained weight loss can improve, and possibly reverse, this disease process and significant weight loss with these methods is difficult to achieve and harder to maintain. If caught early enough the liver is the only internal organ that can regenerate after an injury, but once significant scarring or cirrhosis has set in, it’s too late. Currently, a national multi-center research network is looking at Vitamin E and a diabetes drug called Metformin, as possible therapy for FLD. But, as of today, the best and only reliable way to prevent the damaging effects of obesity on the liver is to lose the excess body weight.
At The N.E.W. Program we screen all patients for FLD prior to surgery. A simple, non-invasive ultrasound test of the abdomen can detect excess fat in the liver as well as enlargement of the liver. If this disease process is discovered by ultrasound, further testing may be required.
Several recent studies have shown the positive benefit of surgical weight loss on Fatty Liver Disease. In one study, obese patients had liver biopsies taken both before surgery and again 15 months after surgery, when significant weight loss had been accomplished. Many patients showed dramatic improvement, and some had complete resolution, of the excess liver fat as well as the inflammation and fibrosis that was seen before surgery. These results highlight the important role that obesity plays in liver disease and reinforce the benefits of surgical weight loss in severely obese adolescents.