Fatty Liver in Children, an Epidemic We Can Reverse

There is a silent, spreading-like-wildfire health epidemic affecting our youth, negatively impacting their health today and hindering their full health potential well into adulthood, and it’s called nonalcoholic fatty liver disease (NAFLD). Driven by factors like obesity, a lack of regular exercise, and a diet devoid of adequate nutrients and full of processed and sugary foods, children and adolescents are directly feeling the effects of this rapidly growing disease, characterized by too much fat stored in liver cells. According to one report, the incidence of NAFLD in children and adolescents (0-17 years) has increased by nearly 170% since 2017,1 and we are failing them by ignoring the problem. But with awareness and action, this is an epidemic we can reverse, giving our children the gift of good health and setting them up for a long, healthy life.

 

Illustrations of two children

You Are Only as Healthy as Your Liver

As the largest internal organ in the body, the liver is a heavy lifter. It removes toxins, maintains healthy blood sugar levels, regulates blood clotting, stores and even makes certain vitamins and minerals, regulates amino acid levels, plays a role in healthy digestion, and more. In fact, it performs more than 500 vital functions in the body, so keeping the liver healthy is crucial for overall health.2

When it comes to liver disease, there’s a long-running misconception that you can only damage the liver by drinking too much alcohol, using drugs, or by taking medications that can harm this vital organ (one reason NAFLD goes unrecognized in children), but the reality is that risk factors like obesity, a sedentary lifestyle, and a poor diet wreaks havoc on liver health—and are the main factors contributing to the rise of NAFLD in children and adolescents.

NAFLD in children is associated with hyperlipidemia (excess fat in the blood), insulin resistance, and obstructive sleep apnea.3 Studies also show that children and young adults with NAFLD have significantly higher rates of cancer, liver-related death, and cardio-metabolic mortality.4 According to research, “The worldwide prevalence of NAFLD in children is a worrying phenomenon because this disease is closely associated with the development of both cirrhosis and cardio-metabolic syndrome in adulthood.”5

According to one report, the incidence of NAFLD in children and adolescents (0-17 years) has increased by nearly 170% since 2017.1

Over the past decade, the incidence of NAFLD has increased significantly in children. The percentages of age groups diagnosed with NAFLD are as follows: adults (25%), adolescents 15 to 19 years (17%), children 10 to 14 years (11%) and children ages 5 to 9 years (3%).6 What’s more, approximately one-third of obese male children and one-quarter of obese female children are estimated to have NAFLD.7 Race can also determine the risk of NAFLD, with Asian-American and Latino children thought to be at a higher risk compared to their white and African-American counterparts.8 9 Although the majority of children with NAFLD are overweight or obese, there is an increasing subset of children with a normal body mass index with so-called “lean NAFLD.”

Research has determined that “The current standard-of-care treatment of NAFLD in children is lifestyle change and increased physical activity.” In other words, a better diet and more movement.

Less Screens, More Steps

Illustration of a child holding a tablet and another walking

How can we motivate our kids to get active again? Reduce screen time, for starters. Our “smart” technology has played a huge role in this modern health crisis—in the last decade, an increase in screen time has led to an increase in a sedentary lifestyle and obesity rates among children and adolescents. On average, children ages eight to 12 in the United States spend four to six hours a day watching or using screens from televisions, smartphones, tablets, or computers. Teens spend up to nine hours a day on said devices. While screens can entertain, teach, and keep children occupied, too much use can lead to problems such as sleep issues, weight problems, less time outdoors and a reduction in physical activity.10 11 12 13 14

Yes, it can be challenging, but reducing your child’s screen time opens up room for more play and movement. It may take some encouragement on your part, but even something as simple as a daily family walk goes a long way! A 2023 study found that just 150-minutes of moderate to intense exercise a week significantly reduces liver fat.15

4 Nutritional Tips to Maximize Your Kids’ Health and Combat NAFLD as a Family

  1. Raid your pantry and pitch the processed foods. Avoid fast food. Cut out sodas and other sugary drinks. You’ve heard this before: processed foods are just not good for you or your kids, even in moderation. They’re loaded with artificial flavors, colors, additives, and preservatives and are over-processed, stripping the “food” of any nutritional value. They are also a main driver of the development of NAFLD.16 Saying no to drinks with high-fructose corn syrup is particularly important. Fructose induces liver inflammation, promotes insulin resistance, and dyslipidemia—abnormally elevated fats (lipids) in the blood—all of which are linked to the development of fatty liver disease.17
  2. When it comes to prioritizing liver health—and overall health—for the whole family, choose organic. Research has found that higher exposures to certain pesticides are associated with higher rates of NAFLD.18 And conventional produce typically has not one, or even two, pesticide residues, but many. Take for example the strawberry, a favorite among children: One Environmental Working Group (EWG) report found 36 types of pesticides on conventional strawberries.19 don’t stop at produce—include a cleanup of your everyday grocery items, too. That’s because studies show that even ultra-low levels of residues of the herbicide glyphosate found in grocery items like cereal, oatmeal, crackers, etc., can increase the risk of developing NAFLD.20
  3. Eat more organic fruits and veggies and grass-fed, humanely raised meats. Incorporate fruits, such as berries that can reduce inflammation in the liver, leafy greens that contain fiber and nutrients like vitamin K to support liver health, cruciferous veggies like cabbage, broccoli, and cauliflower that can help protect the liver against environmental chemicals, and grass-fed meats and wild-caught fish that contain higher ratios of healthy omega-3s as well as liver-protective, anti-inflammatory, and antioxidant nutrients.21 22
  4. Supplement wisely. A multivitamin provides all of the foundational nutrients and is a good idea for any child or adolescent. Supplements that have been specifically researched for NAFLD include the omega-3 fats EPA and DHA, ginger, and polyphenols including resveratrol, quercetin, and curcumin. The omega-3s have been shown to reduce liver inflammation, increase insulin sensitivity, and decrease triglyceride levels in pediatric NAFLD.23 Ginger supplements were shown to improve liver enzymes and have a beneficial effect on liver function and insulin resistance,24 while polyphenols like resveratrol have been found to reduce inflammation and oxidative stress in the liver as well as improve liver enzymes.25
Illustrations of two children eating fruit and vegetables

It’s up to us as adults to ensure we give our children the foundation they need for a lifetime of good health. With less screen time, more movement, a cleanup of their diet, and a few select supplements, a healthy liver—and a healthy body—are possible.

 

References


  1. Cha, A. E. (2023, October 3). Fatty liver disease rising in U.S. kids as ultraprocessed diets surge. Washington Post. https://www.washingtonpost.com/health/interactive/2023/nonalcoholic-fat…
  2. The liver and its functions. (n.d.). https://columbiasurgery.org/liver/liver-and-its-functions#:~:text=The%2….
  3. Professional, C. C. M. (n.d.). Hyperlipidemia. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21656-hyperlipidemia
  4. Simon TG;Roelstraete B;Hartjes K;Shah U;Khalili H;Arnell H;Ludvigsson JF; “Non-Alcoholic Fatty Liver Disease in Children and Young Adults Is Associated with Increased Long-Term Mortality.” Journal of Hepatology, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/34224779/.
  5. Mann, J., Valenti, L., Scorletti, E., Byrne, C., & Nobili, V. (2018). Nonalcoholic fatty liver disease in children. Seminars in Liver Disease, 38(01), 001–013. https://doi.org/10.1055/s-0038-1627456
  6. Yu, Elizabeth L, and Jeffrey B Schwimmer. “Epidemiology of Pediatric Nonalcoholic Fatty Liver Disease.” Clinical Liver Disease, John Wiley and Sons Inc., 13 Apr. 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043694/.
  7. Yu, E. L., Golshan, S., Harlow, K. E., Angeles, J. E., Durelle, J., Goyal, N. P., Newton, K. P., Sawh, M. C., Hooker, J., Sy, E. Z., Middleton, M. S., Sirlin, C. B., & Schwimmer, J. B. (2019). Prevalence of Nonalcoholic Fatty Liver Disease in Children with Obesity. The Journal of Pediatrics/the Journal of Pediatrics, 207, 64–70. https://doi.org/10.1016/j.jpeds.2018.11.021
  8. Malespin, M., Sleesman, B., Lau, A., Wong, S. S., & Cotler, S. J. (2015). Prevalence and correlates of suspected nonalcoholic fatty liver disease in Chinese American children. Journal of Clinical Gastroenterology, 49(4), 345–349. https://doi.org/10.1097/mcg.0000000000000121
  9. Welsh, J. A., Karpen, S., & Vos, M. B. (2013). Increasing prevalence of nonalcoholic fatty liver disease among United States adolescents, 1988-1994 to 2007-2010. The Journal of pediatrics, 162(3), 496–500.e1. https://doi.org/10.1016/j.jpeds.2012.08.043
  10. Aacap. (n.d.). Screen time and children. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-G…
  11. Qi, J., Yan, Y., & Yin, H. (2023). Screen time among school-aged children of aged 6–14: a systematic review. Global Health Research and Policy, 8(1). https://doi.org/10.1186/s41256-023-00297-z
  12. Hu J, Ding ZY, Han D, et al. Analysis of influencing factors of myopia among primary and middle school students in Suzhou. China J Pre Med. 2021;33(03):241–5.
  13. An MJ, Chen TJ, Ma J. The relationship between screen time and overweight among primary and middle school students in Fangshan District, Beijinh. Chin J Sch Health. 2018;39(04):506–8.
  14. Liu ZH, Liu ZY, Lv SH. The relationship between video time and self-harming behavior among pupils in five provinces of China. Chin J Sch Health. 2021;42(03):363–6.
  15. Stine, J. G., DiJoseph, K., Pattison, Z., Harrington, A., Chinchilli, V. M., Schmitz, K. H., & Loomba, R. (2022). Exercise training is associated with treatment response in liver fat content by magnetic resonance imaging independent of clinically significant body weight loss in patients with nonalcoholic fatty liver disease: A Systematic Review and Meta-Analysis. The American Journal of Gastroenterology, 118(7), 1204–1213. https://doi.org/10.14309/ajg.0000000000002098
  16. Henney, A. E., Gillespie, C. S., Alam, U., Hydes, T. J., & Cuthbertson, D. J. (2023). Ultra-Processed Food Intake Is Associated with Non-Alcoholic Fatty Liver Disease in Adults: A Systematic Review and Meta-Analysis. Nutrients, 15(10), 2266. https://doi.org/10.3390/nu15102266
  17. Coronati M;Baratta F;Pastori D;Ferro D;Angelico F;Del Ben M; “Added Fructose in Non-Alcoholic Fatty Liver Disease and in Metabolic Syndrome: A Narrative Review.” Nutrients, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/35334784/.
  18. Sang, H., Lee, K. N., Jung, C. H., Han, K., & Koh, E. H. (2022). Association between organochlorine pesticides and nonalcoholic fatty liver disease in the National Health and Nutrition Examination Survey 2003-2004. Scientific reports, 12(1), 11590. https://doi.org/10.1038/s41598-022-15741-2
  19. Mesnage, Robin, et al. “Multiomics Reveal Non-Alcoholic Fatty Liver Disease in Rats Following Chronic Exposure to an Ultra-Low Dose of Roundup Herbicide.” Scientific Reports, Nature Publishing Group, 9 Jan. 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5220358/.
  20. Hepatitis B Foundation: Healthy liver tips for children. (n.d.). https://www.hepb.org/treatment-and-management/children-with-hepatitis-b…
  21. Rd, J. K. (2024, January 9). The best foods you can eat for a healthy liver. Health. https://www.health.com/foods-to-eat-for-a-healthy-liver-8406188#:~:text….
  22. Rahimlou, M., Ahmadnia, H., & Hekmatdoost, A. (2015). Dietary supplements and pediatric non-alcoholic fatty liver disease: Present and the future. World journal of hepatology, 7(25), 2597–2602. https://doi.org/10.4254/wjh.v7.i25.2597
  23. Zhou, Q., Peng, Y., Chen, F., & Dai, J. (2023). Ginger supplementation for the treatment of non-alcoholic fatty liver disease: a meta-analysis of randomized controlled trials. African health sciences, 23(1), 614–621. https://doi.org/10.4314/ahs.v23i1.65
  24. Rahimlou, M., Ahmadnia, H., & Hekmatdoost, A. (2015). Dietary supplements and pediatric non-alcoholic fatty liver disease: Present and the future. World journal of hepatology, 7(25), 2597–2602. https://doi.org/10.4254/wjh.v7.i25.2597
  25. Rahimlou, M., Ahmadnia, H., & Hekmatdoost, A. (2015). Dietary supplements and pediatric non-alcoholic fatty liver disease: Present and the future. World journal of hepatology, 7(25), 2597–2602. https://doi.org/10.4254/wjh.v7.i25.2597