THE DOCTOR IS IN
OP / ED BY DR. ADIL MANZOOR
It is not uncommon to have conditions that affect adults and children alike; consider the common cold, conjunctivitis, RSV, ear infections, and the like. In the same way, some conditions are predominant in just one of these groups, that is, conditions that affect mainly adults and conditions that affect mainly children. Among the conditions that are typically associated with adults are hypertension, gallstones, and, of course, fatty liver disease.
However, over the years, many of the conditions that are generally associated with adults have become increasingly common in children. Our focus for this article is fatty liver disease.
Let me begin with a story. A woman with an 8-year-old daughter noticed that her kid was sick and took her to the hospital. On getting there, the doctors told the woman that her daughter had fatty liver disease. At this point, the woman was not surprised; she was confused, simply because that is a condition you will expect from older adults. And not just older adults but those who neglected their health and drank a lot. So, how come her 8-year-old jewel has this condition, she wondered?
She knew that her daughter had put on weight over the last year, quite all right, but she still did not show any signs of poor health. Something must be wrong somewhere. Maybe a mistake in diagnosis?
Well, unfortunately, there was no mistake in the diagnosis. Her daughter truly had the condition, and while it came as a surprise to her, it wasn’t to the doctors managing the child. Over the last two decades, these conditions have become more frequent among children. There have been plenty of studies on identifying these conditions in kids, which have been fruitful. Nowadays, doctors can accurately tell which kids have the condition and its severity. But one question science has not been able to answer definitively is why. Why are 8-year-olds having fatty liver disease?
I have gone through a fair share of publications and studies, and I have been able to pool reasonable information to answer this question – or, should I say, attempt to answer the question – but before that, let me brush over the condition.
Fatty liver disease is a condition in which excess fat accumulates in liver cells. While some fat in the liver is normal, if it exceeds 5-10%, the condition is known as fatty liver disease. There are many different predisposing factors, but the condition has been grouped into two main classes, which are alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD).
As you would imagine, the major difference between these classes is the predominant cause of the liver condition. In recent years, there have been discussions to bin the name alcoholic and non-alcoholic in light of the several different potential causes of these conditions. For the sake of this article, though, I will refer to the old names.
Among children, NAFLD is the typical fatty liver disease observed. Considering fatty liver disease is a result of a buildup of fat, it is (or was) not common to have children with the condition. But doctors note that recently, they treat kids with as much as 40% of fat in their liver cells. That’s just insane.
The exact reason children are getting this condition is unknown. However, it is widely attributed to the change in diet since the turn of the century. The shift from truly healthy eating to ultra-processed junk foods has been massive, and scientists believe this has affected the body in many ways. For one, it has increased the toxin load on the liver and altered how it processes food. This has led to the accumulation of fat in the liver.
Another line of thought is that these junk foods affect the normal gut microbiome, which contains a lot of “good bacteria” that help to digest food. A disruption in gut health means poorer food metabolism, which puts more strain on the liver, the chief metabolizing organ. A less common but equally valid explanation is genetics.
Regardless of the cause, it is beyond dispute that urgent action is needed. Scientists believe a healthy diet consisting of fruits and vegetables, as well as physical activity can reduce the occurrence and progression of fatty liver disease to more dangerous conditions like cirrhosis.
This article was written by Dr. Adil Manzoor, DO, a Board-Certified Internist & Board Certified Pediatrician who works as a Hospitalist and Emergency Room Physician. He is also the current President of Garden State Street Medicine, a non-profit organization whose sole purpose is to provide free preventive and acute urgent care services for the homeless. He is also the co-founder of his own unique medical practice, Mobile Medicine NJ & House Call Doctors. He is also currently pursuing an Executive MBA and a Master’s of Science in Healthcare Leadership at Samuel Curtis Johnson Graduate School of Management and the Weill Cornell Graduate School of Medical Sciences.
References
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2757471/
- https://www.washingtonpost.com/health/interactive/2023/nonalcoholic-fatty-liver-disease-kids/
- https://childliverdisease.org/liver-information/childhood-liver-conditions/non-alcoholic-fatty-liver-disease/
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