Increasing numbers of children develop non-alcoholic fatty liver disease, which can end in liver cirrhosis. Doctors in Denmark are now warning about this neglected disease because the long-term effects and prevalence are unknown. New methods of investigating this are needed to diagnose and treat children in time.
Three decades ago, obese people older than 50 years and with type 2 diabetes comprised nearly all the people developing non-alcoholic fatty liver disease. Since then, however, the number of children in Denmark who are overweight has tripled to one in eight children. A very serious effect of this increase in obesity is non-alcoholic fatty liver disease, a chronic liver disease that can have important outcomes.
“We are familiar with the course of disease among adults that are diagnosed in their fifties. These people have an increased risk of both chronic liver failure and liver cancer. However, since non-alcoholic fatty liver disease was rare among children until recently, we simply do not know the long-term effects” explains an author of an article in the Danish medical journal Ugeskrift for Læger, Henning Grønbæk, Professor, Department of Clinical Medicine and Department of Hepatology and Gastroenterology, Aarhus University Hospital.
New practices required
Danish doctors are sounding the alarm because new international research shows an increased prevalence of the disease among young people. A United States autopsy study revealed that 38% of overweight children had non-alcoholic fatty liver disease. A Danish study of obese children at the Christmas Seal Foundation’s Children’s Homes used ultrasound scanning to show that 43% had a fatty liver and 50% had elevated liver enzymes.
Unfortunately, we do not know the prevalence among children and adolescents in Denmark because liver biopsy is the only reliable diagnostic method. And although liver biopsy has a very low risk, important ethical considerations require us to avoid doing this unless we seriously suspect that someone has the disease.
Grønbæk and his colleagues therefore advocate that obese children should assess the disease risk based on body mass index and waist size and then assessing the people with the highest risk through ultrasound scanning and liver enzymes. Biopsy may be offered if these tests confirm a high likelihood of the disease.
“The symptoms are most often silent, and non-alcoholic fatty liver disease develops over decades with potentially serious effects. Nevertheless, the opportunities for complete cure are excellent if someone is treated in good time.”
Only one cure
Today, the only cure for non-alcoholic fatty liver disease is lifestyle intervention with exercise and reducing calorie intake. Although sustained lifestyle changes can completely cure the disease, a Danish study showed that children with the disease on average lost 7–10 kg over 10 weeks, but only one fourth of them maintained that weight loss 12 months later.
Changing lifestyle is the only effective cure known today. There are several pharmaceutical treatments and many indications that research on the gut microbiome may help to discover new treatment methods such as probiotics. However, the only cure currently is more exercise and a healthier diet.
Although Grønbæk is concerned about the increasing prevalence and the unknown long-term effects of non-alcoholic fatty liver disease among children, he believes that increasing the focus on this problem may help children and adolescents from an adult life with more severe liver disease.
“Children’s bodies are much more plastic than those of adults, so when a child becomes physically active and loses several kilograms improvements may happen rapidly. The most important thing now is increasing the focus on the disease, its effects and the opportunities so that both the children and adolescents and their parents can react in good time.”
“Non-alcoholic fatty liver disease in children and adolescents [Nonalkoholisk fedtleversygdom hos børn og unge] has been published in Ugeskrift for Læger. In 2014, the Novo Nordisk Foundation awarded a grant to an author, Henning Grønbæk, for the project Inflammatory Liver Diseases and the Role of Hepatic Macrophages.