An Epidemic of Silent Liver Disease in Kids
Ana Hurtado's son Arturo is an outstanding baseball pitcher who also plays basketball and flag football. At age 12, he's 5'7" tall and weighs 187 pounds. "I call him my little giant," his mom says. Arturo, who lives in Chula Vista, Calif., also has a potentially life-threatening condition that until recently has been rare in children. As childhood obesity has risen, so have reports of fatty liver disease in kids like Arturo, a condition, like high blood pressure and diabetes, that is more common in adults who are overweight and obese. When the liver fails to break down fats as it normally would, fat accumulates in liver cells and can damage the organ.
For the first time, researchers have calculated the number of children in the United States with fatty liver disease, and it isn't pretty: 9.6 percent of children ages 2 to 19. Of those, one quarter have hepatitis, which includes liver damage and inflammation. And of that 25 percent, about 1 in 10 already have cirrhosis, or scarring of the liver. Cirrhosis is a life-threatening condition, which can lead to liver failure, cancer, or massive internal bleeding.
"This is a tremendous public health crisis," says Jeffrey Schwimmer, an associate professor of pediatrics at the University of California, San Diego Medical School, and author of the study, in this month's Pediatrics. "This is not simply a matter of children who are overweight going on to someday develop problems. A large number of children already have extremely serious health consequences."
The major risk factor is obesity; 80 percent of children with fatty liver disease are overweight or obese. Ethnicity is also a factor; Hispanic and Asian people are more likely to have it than whites or blacks. Fatty liver can be hard to diagnose without a liver biopsy; Schwimmer's study used autopsy results from children killed in accidents. But "screening tests and evaluation by a liver specialist can go a long way toward sorting out if a child has a problem," Schwimmer says. There are no drugs on the market for treating fatty liver, although some are being studied. Instead, doctors recommend lifestyle changes, including more exercise and a healthier diet, which can reverse the condition for many people.
Arturo's fatty liver disease was diagnosed only because his pediatrician was concerned that the boy might have diabetes and did blood tests. Elevated liver enzymes led to a liver biopsy. Although Hurtado thinks that Arturo's disease may be caused by genetics, she's altering the whole family's diet to reduce the risk to all three of her children. "We already used 2 percent milk and canola oil," says Ana Hurtado. "We went to fat-free milk, we use Eggbeaters, and we're really careful on portions." Arturo isn't always thrilled about being told he's having grilled chicken on salad instead of a hamburger. "Sometimes he gets upset," his mother says. "At 12 years old, they have big appetites. But at least he's aware. It's something we work on every day."
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