WHAT IS THE FATTY LIVER DISEASE?
In recent years, Fatty Liver Disease or Non-Alcoholic Fatty Liver Disease (NAFLD) in children and adolescents has increased and is now one of the most common forms of chronic liver disease in children and adolescents.
Before we talk about NAFLD, let’s understand the importance of the liver in our body. The liver is probably one of the most active organs in our body – it takes food directly from the stomach and processes fat, carbohydrates and protein into energy and other proteins.
NAFLD happens when there is an imbalance in the functioning of the liver and could be a result of too much fat coming into the liver cell. This excessive fat in the liver either, overwhelms the functioning of the liver or its ability to process i.e. metabolise the fats/ carbohydrates. In simple terms, fatty liver disease or Non-alcoholic Fatty Liver Disease (NAFLD) is a type of liver disease that happens when excessive fat is stored in the liver. NAFLD is more common in boys than girls.
In fact, NAFLD actually refers to a group of conditions that can be better understood in terms of different stages:
- Simple Fatty Liver Disease – when a child has excessive accumulated fat in the liver but there is no inflammation or cell damage.
- Non-alcoholic Steatohepatitis (NASH) – when the accumulated fat in the child’s liver leads to inflammation and cell damage.
- NASH with Fibrosis – when there is scarring in the liver that causes damage
- Cirrhosis – this is usually a result of long-term and continuous damage to the liver. The soft, smooth liver tissue is replaced by irregular bumps (known as nodules) and this makes the liver harder. The many important functions of the liver are then hampered and eventually stops working resulting in end-stage liver disease. And the only solution is a liver transplant.
WHO IS AT RISK OF DEVELOPING NAFLD?
The following children are at a greater risk of developing NAFLD:
- Children who are overweight or obese
- Children who have developed insulin resistance
- Children with type-2 diabetes
- Children who follow a poor diet and do little or no exercise
- Children who carry certain variations in their genes
- Children who have high lipid disorders i.e. high blood levels of low-density lipoprotein(LDL) cholesterol, and fats called triglycerides, or both. High levels of these substances increase the risk of developing heart disease.
WHAT ARE DANGERS OF NAFLD?
Fatty liver disease might have some serous lifelong problems and hence early treatment is extremely important. Over time, fatty liver disease gets serious and could result into serious liver damage.
Fatty liver disease is also known as the silent disease as it doesn’t show symptoms in the early stages, and as the disease progresses it can develop into non-alcoholic steatohepatitis (NASH). NASH, in fact, has now become the number one reason for liver transplantation.
WHAT ARE THE SIGNS & SYMPTOMS OF NAFLD?
In the early stages of NAFLD, most children do not show any symptoms, and it is only when significant damage to the liver has happened that the signs & symptoms become more obvious.
Some common symptoms of NAFLD are:
- Pain in the abdomen
- Fatigue
- Irritable nature accompanied with low mood and anxiety
- Recurrent headaches
- Difficulty in concentrating
- Changes in skin colour where two areas of skin touch and/ or around joints
When NAFLD enters a more advanced stage, such as Cirrhosis, the symptoms are:
- Yellowing of the skin and the whites of the eyes (jaundice)
- Itchy skin
- Swelling in the lower abdomen
- Easy bruising
- Dark urine
HOW IS NAFLD DIAGNOSED IN CHILDREN?
There are no specific tests that diagnose NAFLD and most children are diagnosed when they are having tests for something else, namely routine blood tests and ultrasound scans.
During routine blood tests, pediatricians might notice higher-than-normal levels of certain liver enzymes and this might indicate the existence of the condition. Obese children are more likely to show these higher-than-normal levels of liver enzymes. In such cases, pediatricians would refer the child to a pediatric gastroenterologist who will order an ultrasound to look at the structure of the liver. Additionally, a transient elastography known as a FibroScan would also be done that measures ultrasound waves through the liver to predict liver stiffness or liver scarring and also the amount of fat.
In some cases, the pediatric gastroenterologist might need to do a needle biopsy to look for signs of fat buildup and scarring in the liver. The needle biopsy will tell the doctor whether the child has a simple non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH).
HOW IS FATTY LIVER IN CHILDREN TREATED?
Unfortunately, researchers and doctors have not been able to figure out a simple cure for NAFLD. Doctors focus on preventing the disease from getting worse and for that they suggest the following:
- Encouraging parents to ensure that their children develop healthy eating habits. Doctors recommend a dietician for advice.
- Advise on weight loss for obese children
- Maintaining a stricter control of blood sugar levels for children with diabetes
- Monitoring the child for complications or progression from NAFLD to more severe NASH.
WHAT SHOULD, I AS A MOTHER DO IF MY CHILD/ TEEN IS DIAGNOSED WITH NAFLD?
If your child is diagnosed with NAFLD, mothers need to play a far more active role to stop the progression of the condition. Apart from undergoing periodic medical follow-ups, mothers need to ensure a change in lifestyle with a major focus on healthy eating and increasing activity. This can help in reversing the condition completely even when significant scarring is present.
Mentioned below are some tips on getting started:
