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Eating a healthy (balanced) diet, limiting sugars and salt, consuming lots of green leafy vegetable and fresh fruits along with regular exercise helps in reducing weight and therefore reducing the risk of fatty liver.
Fatty liver disease is increasingly being recognised as a major health burden in almost all countries across the world. There are many reasons behind this, and lifestyle plays a big role in the development of this disease. Even children are not spared. Recently, an observational study, TARGET-NASH, confirmed that there is a higher prevalence of non-alcoholic fatty liver disease (NAFLD) in paediatric patients than previously suspected. Researchers of this study came to this conclusion after following data of 660 paediatric patients for five years.
Another study published in the Journal of Pediatrics says that weight gain may have a negative impact on liver health in children as young as 8 years old. According to this study, a bigger waist circumference at age 3 increases the possibility that, by the age of 8 years, children will have markers for non-alcoholic fatty liver disease. There is a significant link between the fast food consumption of pre-schoolers and obesity. Hence, the need of the hour is to wean children away from fast food and towards a healthier diet.
In India also, a steep rise in non-alcoholic fatty liver disease is causing concern among paediatricians and parents. To create awareness around this health issue and to help parents and caregivers navigate through the intricacies of this disease, we reached out to Dr. Shailesh Sable, Consultant- Liver transplant & HPB surgeon, Apollo Hospitals, Navi Mumbai. He answers a few pertinent questions related to this disease in children.
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Answer: Fatty liver disease occurs when too much fat accumulates in the liver. Fat triggers inflammation (leading to injury of liver or hepatocytes) and leads to fibrosis (scarring) and ultimately end stage liver disease called cirrhosis. Childhood obesity is rising since last 2 decades and it's also directly correlating with simultaneous rise in paediatric fatty liver disease. Parents are unaware that obesity has a direct relationship with diabetes (type 2) and metabolic syndrome, which is also a perfect recipe for fatty liver disease. The main reason behind this is sedentary lifestyle and unhealthy eating habits (fast food or preserved foods). However, not all fatty liver diseases are related to obesity. There are also some genetic mutations, which can lead to fatty liver (mainly related to cholesterol homeostasis).
Answer: It is generally a symptomless condition (silent disease). But as the disease progresses to fibrosis and/or cirrhosis stage it can interfere with critical functions of liver. Let's look at the symptoms of fatty liver disease in children here -
Answer: Eating a healthy (balanced) diet, limiting sugars and salt, consuming lots of green leafy vegetable and fresh fruits along with regular exercise helps in reducing weight and therefore reducing the risk of fatty liver. However, not all fatty livers are associated with obesity alone. Lowering cholesterol with the help of medications are sometimes indicated under specialist medical supervision. There is no medicine approved for fatty liver disease. But some studies indicate that vitamin E and anti-diabetic drugs may help but this is still in an experimental stage. Till a cure is found, a balanced diet and regular exercise remains the golden standard therapy.
Answer: Screening for fatty liver is a controversial topic at this moment and not recommended partly because there's no treatment other than weight loss. There is also no screening tool at present for this disease. Commonly used modalities by most of the clinicians are ultrasonography (USG) of liver (prone to inter-observer variation) and liver function test (AST/ALT) to check inflammation in liver. MRI of the liver is used in rare cases only to grade the fat in the liver. But this requires sedation of smaller kids, high cost and claustrophobia, which limits its utility.
Answer: Fatty liver disease is a spectrum of disease ranging from mild fat accumulation in the liver (fatty liver) to NASH or non-alcoholic steatohepatitis (inflammation in fatty liver) to cirrhosis (end stage liver disease). Cirrhosis (scarring of liver) due to inflammation is rare in children, but it's a concerning long term complication that leads to end stage liver disease. Cirrhosis presents with jaundice, ascites (fluid in tummy), encephalopathy (disorientation/ coma), and dysfunction of other organs like kidneys, heart and lungs.
Liver maintains the body's metabolism, helps in clearing toxins and waste products, provides immunity (filtering bacteria from blood), manufactures proteins and cholesterol and helps blood clotting, etc. If it stops working due to cirrhosis (end stage liver disease) then liver transplantation is the only life-saving treatment option available.