Fighting Fatty Liver Disease in Children

A Silent Disease

Fatty liver diseaseTypically, “fatty liver disease” struck alcoholics.

But in the past decade, Dr. Miriam Vos, a pediatric hepatologist at Children’s Healthcare of Atlanta, has seen a dramatic uptick in the cases involving children.

Some of that is due to better reporting, said Vos, a national expert in pediatric fatty liver disease. But most of the increase is due to a dramatic rise in prevalence–with an estimated 7 million children–or one in 10–having it.

Vos and her colleagues found in reviewing national data that the percentage of children suspected of having the disease grew to 10.7 percent between 2007 and 2010, up from about 4 percent between 1988 and 1994.

“When I started researching this in 2003, there were maybe five strong publications to pull from,” said Vos. “Now there is easily more than 500. People are now aware of it–and interested in finding ways to halt it.”

Although known as a “silent” illness, fatty liver disease can eventually progress over the years to NASH–or nonalcoholic steatohepatitis—when the liver becomes inflamed. From there, the disease can progress to deadly cirrhosis, where the liver develops scar tissue and stop functioning.

Those with fatty liver disease are also eight times more likely to develop cardiovascular disease, she said. The disease is also linked to diminished cognitive function and a higher rate of Type II diabetes among patients as they age.

Unfortunately, solving fatty liver disease is not as easy as putting kids on a diet. Although it is strongly linked to obesity–there is not necessarily a direct correlation, Vos said.

About 40 percent of obese children have been found to have fatty liver disease, but it also is appearing in children who have a normal BMI.

And most disconcerting, Vos says, is while obesity rates are leveling off, the prevalence of fatty liver disease continues to rise.

“Basically, you don’t have to be any specific weight to have fatty liver disease,” Vos says. “Although it can be tied to being overweight or obese, we suspect there are strong genetic and environmental components.”

For example, fatty liver disease is relatively rare in the African-American population, she said, but it’s common among those with Latino heritage.

“They have super-high rates,” she says. “In one screening study, 75 percent of Hispanic adolescents had it.”

In response, Vos and her team are working on a number of ways to stop or stem the rate of fatty liver disease, with pharmaceutical solutions being a key goal.

But they are also looking at the effectiveness of screening adolescents for the disease as part of their well child check-ups in hopes of catching those at risk before the illness takes place.

And researchers are also looking for biomarkers tied to triggers that occur under certain environmental influences–such as sugar-laden foods, or even overweight pregnant moms.

“Once you get it, it’s very hard to get rid of it,” Vos says. “But we believe we can greatly improve the situation by reducing the sugar and upping the amount of vegetables and fruits. By increasing exercise.”

And the more researchers discover, the better the treatment plans will be, she says.  Currently, two CHOA clinical trials, funded by the National Institutes of Health, are underway to find better protocols to avoid or stop fatty liver disease.

“The holy grail is to prevent it in children. Period,” Vos said. “But until then, we’re going to seek targeted approaches to reduce its effects.”