Dr Shailesh Sable

We are seeing a rising incidence of fatty liver, and even among children. What are the reasons behind it?

Fatty liver disease occurs when there’s too much fat accumulating in the liver. Fat triggers inflammation (leading to injury of liver or hepatocytes) and results into healing by fibrosis (scarring) and ultimately end-stage liver disease called cirrhosis. Childhood obesity has been rising over the past two decades and it’s also directly correlating with simultaneous rise in paediatric fatty liver disease. Parents are unaware that obesity has a direct relationship with diabetes (type 2) and metabolic syndrome, which is also a perfect recipe for fatty liver disease. The main reason behind this is a sedentary lifestyle and unhealthy eating habits (fast food or preserved foods). However, not all fatty liver diseases are related to obesity; there are also some genetic mutations that can lead to fatty liver (mainly related to cholesterol homeostasis).

What are the symptoms of fatty liver?

It is generally a symptomless condition (silent disease). But as the disease progresses to fibrosis and/or cirrhosis stage, it can interfere with critical functions of the liver. In the early stages, symptoms could be easy fatigue or feeling of tiredness or subtle discomfort in the right upper abdomen. Stage of cirrhosis may present with jaundice, fluid in the tummy or swelling over legs, disorientation or excessive day-time sleepiness, etc.

Can diet change and exercise alone help?

Eating a healthy (balanced) diet, limiting sugars and salt, consuming lots of green leafy vegetables and fresh fruits along with regular exercise helps reducing weight and, therefore, reduce fatty liver. However, not all the fatty livers are associated with obesity alone. Lowering cholesterol with the help of medications are sometimes indicated under specialist medical supervision. There is no medicine approved for fatty liver disease, and some studies indicate role of vitamin E and anti-diabetic drugs, but they remain experimental. Till then, a balanced diet and regular exercise remain gold standard therapy.

What can parents do to check this among children?

Screening for fatty liver is a controversial topic at this moment and not recommended partly because there’s no treatment other than weight loss and there is non-availability of the perfect screening tool. Commonly used modalities by most of the clinicians are ultrasonography (USG) of liver (prone to inter-observer variation) and liver function test (AST/ALT) to check inflammation in liver. Rarely, MRI of the liver can be used to grade the fat in the liver; however, requirement of sedation in smaller kids, high cost and claustrophobia limits its utility.

What can be the complications if the disease progresses unchecked?

Fatty liver disease is a spectrum of disease ranging from mild fat accumulation in liver (fatty liver) to NASH or non-alcoholic steatohepatitis (inflammation in fatty liver) to cirrhosis (end-stage liver disease). Cirrhosis (scarring of liver) due to inflammation is rare in children, but it’s a concerning long-term complication that leads to end-stage liver disease. Cirrhosis presents with jaundice, ascites (fluid in tummy), encephalopathy (disorientation/ coma), and dysfunction of other organs like kidneys, heart and lungs. The liver maintains the body’s metabolism, helps clearing toxins and waste products, provides immunity (filtering bacteria from blood), manufactures proteins and cholesterol and helps blood clotting, etc. If it stops working due to cirrhosis (end-stage liver disease), then liver transplantation is the only life-saving treatment option available.

Dr Shailesh Sable is consultant, liver transplant & HPB surgeon, Apollo Hospitals, Navi Mumbai.