Fatty Liver Disease Ups Heart Risks for Obese Kids (HealthDay)

MONDAY, June 30 (HealthDay News) -- More than 6 million childrenin the United States have a condition called nonalcoholic fatty liverdisease (NAFLD), which can boost their odds for heart disease, researchersreport.

NAFLD results from oily droplets of triglycerides forming in livercells. In some children, this can lead to cirrhosis and liver failure andthe need for liver transplant. In others, NAFLD can help cause diabetes,high blood pressure and high cholesterol, all of which are linked tocardiovascular trouble.

"NAFLD is now the most common chronic liver disease in children," notedlead researcher Dr. Jeffrey Schwimmer, an associate professor ofpediatrics at the University of California, San Diego. "We believe thatchildren with NAFLD are at greatest risk for heart disease and diabetes,"he said.

The disease is now so common that between 9 percent and 10 percent ofchildren in the United States have NAFLD, Schwimmer said. "About 80percent of children with NAFLD are overweight," he said.

Approximately 5 percent of these children will develop severe advancedliver disease, Schwimmer said. The majority of children with thiscondition are at risk for developing cardiovascular risk factors leadingto what's known as the metabolic syndrome, he added. Metabolic syndromeboosts heart risks and includes three of these symptoms: abdominalobesity, high blood triglyceride levels, lower levels of "good" HDLcholesterol, elevated blood pressure and elevated fasting blood glucose

The report is published in the July 8 issue of the journalCirculation.

In the study, Schwimmer's team looked at 150 overweight childrendiagnosed with NAFLD, comparing them with 150 overweight children withoutthe condition. Children ranged from five to 17 years of age with anaverage age of 12.7 years.

The team found that children with NAFLD had higher levels of bloodsugar, insulin, total cholesterol, LDL cholesterol (the bad cholesterol),triglycerides and higher blood pressure compared with children withoutNAFLD.

In addition, children with NAFLD had lower levels of HDL cholesterol(the good cholesterol), Schwimmer's group found.

"Overweight children with NAFLD were three times as likely to havemetabolic syndrome as overweight children without NAFLD," Schwimmer said."Overweight children with metabolic syndrome, compared to overweightchildren without metabolic syndrome, have five times the odds of havingNAFLD," he said.

Schwimmer's group noted that more Hispanic and Asian children had NAFLDcompared with white and black children.

NAFLD is becoming more common among overweight children and isassociated with type 2 diabetes and the metabolic syndrome, which putschildren at risk for cardiovascular disease and type 2 diabetes.

"Since 2002, the numbers of children we are seeing with NAFLD and theseverity of the disease we are seeing have both increased a great deal,"Schwimmer said.

Currently, there are no treatments for NAFLD, Schwimmer said."Lifestyle therapy is the main method of treatment. Some people can havetremendous improvement in their disease with nutrition and physicalactivity, but that's not true for everybody," he said.

Overweight or obese children who should be screened for NAFLD includethose with a family history of liver disease or cardiovascular disease ordiabetes, Schwimmer said.

Most people with chronic liver disease will not have symptoms,Schwimmer said. "Approximately 25 percent of people with chronic liverdisease have symptoms. These can be vague and include abdominal pain andfatigue," he said.

"There is a sign that some children will have," Schwimmer said. "Thereis a darkening and thickening of the skin around the neck calledacanthosis nigricans. Many children with NAFLD will have at least somedegree of acanthosis nigricans," he said.

Dr. Sarah de Ferranti, director of the Preventive Cardiology Clinic atChildren's Hospital Boston, labeled NAFLD as yet another seriousconsequence of the obesity epidemic among children.

"The well-publicized pandemic of pediatric obesity has manyconsequences," de Ferranti said. "Nonalcoholic fatty liver disease is aless well known, but increasingly appreciated, late complication of severeobesity that can lead to cirrhosis and liver failure," she said.

"Pediatric practitioners should be aware of the need to look for abroad range of obesity complications, and families will need to understandthat obesity is not purely a cosmetic issue but has important healthconsequences," de Ferranti said. "Unless we address this pediatric obesityaggressively, we will be facing high rates in young adults of not onlydiabetes and heart attack, but also liver disease and the demand for livertransplant."

More information

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