Nonalcoholic Fatty Liver Disease and NASH in Children: Symptoms, Treatment

Overview

Nonalcoholic fatty liver disease (NAFLD) is
an umbrella term for a range of conditions in which excess fat accumulates in
your liver. This buildup is not caused by heavy alcohol use. If heavy alcohol
use leads to the buildup, the condition is called alcoholic liver disease.
NAFLD can be divided into two separate conditions:

  • Simple fatty liver, also called nonalcoholic fatty liver (NAFL)

People with simple fatty liver only have an accumulation of fat in their liver. Little or no inflammation or liver cell damage is found. Generally, it doesn’t cause further damage or complications.

  • Nonalcoholic steatohepatitis (NASH)

Different from NAFL, nonalcoholic steatohepatitis involves not only buildup of fat, but also inflammation of the liver and liver cell damage, which may lead to fibrosis, or scarring of the liver. If the condition gets worse, it can progress to cirrhosis and liver failure.

Children typically develop one of these two
types, though some children with one type may be later diagnosed with the other
one.

As the most common cause of chronic liver disease in children in the United States, NAFLD affects about 10 percent of U.S. children aging 2 to 19. Furthermore, it has become more common in children in recent years. Childhood obesity partly contributes to this phenomenon.

Symptoms

Since nonalcoholic fatty liver disease and
nonalcoholic steatohepatitis usually cause no symptoms, children may not have
any symptoms even if they develop cirrhosis due to NASH. If symptoms do occur, children
may feel tired, become tired easily or feel uncomfortable over the liver.

Causes

The exact cause of NAFLD and NASH hasn’t been identified yet. According to researches, certain genes may make some children more likely to develop NAFLD and NASH.

Some health conditions also increase the
risk of NAFLD and NASH, including:

  • Overweight or obesity
  • Insulin resistance
  • Type 2 diabetes
  • High blood pressure
  • Abnormal levels of fats in the blood
  • Metabolic syndrome

Research shows that NASH is more common in
children with both NAFLD and type 2 diabetes.

Less common causes of NAFLD and NASH in children
involve:

  • Inherited disorders that cause a child’s body to use or store fat abnormally
  • Rapid weight loss
  • Certain infections, such as hepatitis C
  • Certain medicines, such as amiodarone, methotrexate and valproic acid
  • Exposure to some toxins

Diagnosis

In most cases, nonalcoholic fatty liver
disease causes few or no symptoms. Therefore, it is usually noticed when a
liver problem is found during tests for other conditions. Tests used to
diagnose NAFLD include:

Blood tests

  • Complete blood count
  • Liver enzyme and liver function tests
  • Tests for chronic viral hepatitis (hepatitis A, hepatitis C and others)
  • Celiac disease screening test
  • Fasting blood sugar
  • Hemoglobin A1C, which shows how stable your blood sugar is
  • Lipid profile, which measures blood fats, such as cholesterol and triglycerides

Imaging procedures

  • Plain ultrasound
  • Computerized tomography (CT) scanning or magnetic resonance imaging (MRI)
  • Transient elastography
  • Magnetic resonance elastography

Liver tissue examination

If the doctor is not able to make a
diagnosis with other tests, a liver biopsy may be needed. A sample of tissue
from your liver will be removed and then examined in a laboratory to look for
signs of inflammation and scarring.

Treatment

The most effective treatment for NAFLD and NASH is to manage weight. Young children will be recommended to maintain their body weight as their height increases. Avoiding further weight gain is the most important thing. Children who are overweight or obese will need to lose weight so that fat in the liver, inflammation, and fibrosis, or scarring can be reduced.

You can help your children do the following
things so that he or she can manage weight:

  • Improve healthy eating habits
  • Avoid drinking beverages that have added sugar
  • Avoid “fast foods” high in sugar, starch, and fat
  • Be more physically active

If cirrhosis happens, doctors can treat the health problems caused by it with medicines, operations, and other medical procedures. A liver transplant will be necessary if cirrhosis results in liver failure.

Keywords: nonalcoholic fatty liver disease; nonalcoholic steatohepatitis.

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