Nonalcoholic Fatty Liver Disease (NAFLD) in Children

Nonalcoholic Fatty Liver Disease (NAFLD) is the most common forms of chronic liver disease in children and adolescents. It occurs when you have too much fat in your liver. Your liver takes in food directly from the gut and processes fat, carbohydrates and protein into energy and other proteins. An imbalance in this process can result in too much fat coming into the liver cells.

Nonalcoholic Fatty Liver Disease is a group on conditions that occur in different stages:

1. Simple steatosis: fat building up in the liver
2. Nonalcoholic steatohepatitis (NASH): inflammation (swelling in the liver) caused by a buildup of fat
3. NASH with fibrosis: scarring in the liver causing damage
4. Cirrhosis: irregular bumps (nodules) and hardening of the liver, usually due to long-term damage

Why do children get NAFLD?

Children get NAFLD from environmental and genetic factors. Children may be at a higher risk if they:

• Are overweight or obese
• Have insulin resistance
• Have type 2 diabetes
• Follow a poor diet and do little to no exercise
• Have dyslipidemia (irregular level of blood lipids)
• Carry certain variations in their genes
• Have sleep apnea

Some conditions can look like NAFLD and need to be ruled out through investigations because treatments are very different. These conditions may include:

• Malnutrition
• Certain types of metabolic liver disease and cystic fibrosis
• Artificial feeding such as feeding directly into a vein
• Certain medications

What are the signs and symptoms?

It is common for children who have NAFLD to not display any symptoms in the early stages. It is more common for symptoms to develop once significant damage to the liver has occurred.

Some symptoms include:

• Abdominal pain
• Fatigue
• Irritability
• Headaches
• Difficulty concentrating
• Low mood and anxiety
• Changes in skin color near joints and the back of the neck/upper back

If cirrhosis develops, the following symptoms may be present:

• Jaundice (yellowing of the skin and whites of the eyes)
• Itchy skin
• Swelling of the lower stomach
• Bruising easily
• Dark urine

How is Nonalcoholic Fatty Liver Disease diagnosed?

There is no specific test for NAFLD. Most children are diagnosed because they are being tested for something else through routine blood tests and ultrasound scans. In some cases, a liver biopsy may be needed to confirm the diagnosis and assess the liver. It is important to have an honest discussion with your child’s medical provider about their health and lifestyle because liver disease can have very few symptoms.

Can NAFLD be prevented?

NAFLD can be caused by both genetic and environmental factors; therefore, it is not always possible to avoid it. You can reduce your child’s risk through exercise, healthy eating and controlling existing medical conditions.

How is NAFLD treated?

There are currently no approved medications to treat NAFLD, but we know the amount of fat in the liver can be reduced through weight loss, eating healthy and regular exercise. Medical professionals often seek the help of a dietitian.

Diet

Follow a healthy portion-controlled diet and avoid adult-sized portions for children and young people.

Check labels on the food you eat and know what the food you are eating contains. Foods have hidden fats, sugars, and salt.

Swap sugary drinks and breakfast for things like zero sugar/ low calorie drinks or wholegrain cereals with no added sugar.

Increase fiber intake by including beans and lentils in your daily diet.

Aim for five portions of fruit and vegetables a day.

Avoid frying foods and try to grill, bake or poach them instead.

Drink water as the main fluid intake

Activity and Lifestyle

Children and young people should have at least 60 minutes of physical activity a day.

Sleep is just as important. Try to limit screen time and ensure your child is getting enough sleep. Pediatricians recommend less than 2 hours of screen time a day.

Liver transplant

If the liver becomes damaged so much that it can’t work properly a transplant may be needed.

Fatty Liver Disease in Children: An Early Opportunity for Meaningful Change

This presentation by Rachel W Smith, MD and Jaime Chu, MD is an excerpt from the ALF 2021 Poster Competition .

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Questions to Ask Your Doctor

• What condition does my child have that suggests NAFLD?
• Can NAFLD be reversed? How long can this process take?
• What kinds of lifestyle changes and diet can I make for my child?
• Would it be possible to be connected to a registered dietitian or nutritionist to make a specific meal plan?
• What kinds of physical activities would be OK for my child to do?
• Is there a treatment or medication for NAFLD? Are there any clinical trials?
• Will losing weight help to get rid of this disease?

Last updated on February 28th, 2023 at 12:36 pm