National Post, January 18, 2006
Youth could be eating their livers to death: Non-alcoholic disease:
Doctors predict 'epidemic' of illness among children
National Post
Wednesday, January 18, 2006
Page: A13
Section: Body & Health
Byline: Tom Blackwell
Source: National Post
Stuart Williams admits he was overweight and says he sometimes felt sick for no apparent reason. But
the Toronto high school student had little else to complain about when, almost by accident, doctors
discovered a health problem that could have spelled disaster if gone undetected.
Mr. Williams was diagnosed with non-alcoholic fatty liver disease (NAFLD), similar to the illness
brought on by too much drinking, except it is usually the result of packing on too many pounds.
Untreated, patients can eventually develop cirrhosis and need a liver transplant to survive.
"I never knew that being overweight could actually lead to liver disease," the 16-year-old said
yesterday.
His surprise is not shared by pediatric liver specialists. In a paper to be published next month,
Canadian doctors are predicting a worldwide "epidemic" among children of an illness that was once
seen mostly in alcoholics, the latest alarm bell over soaring rates of youth obesity.
Physicians are already seeing an increasing number of child cases of NAFLD, with some actually
reaching the disease's dangerous end point of cirrhosis. Unchecked, the trend could cause major
trouble by the time even mildly ill children become adults, said Dr. Eve Roberts of Toronto's Hospital
for Sick Children, one of the paper's authors.
"I just have this very deep sense that we would feel very sorry if we didn't pay attention to this risk,"
she said.
"I think we would see a generation of young adults with a lot of health problems."
Concern over childhood obesity has mostly focused on its links to heart disease and diabetes. Liver
conditions add another reason to tackle the weight problem seriously, Dr. Roberts said.
The good news is that NAFLD in children can be successfully treated by getting patients to exercise
more and lose weight, and drug therapy may be in the offing.
Non-alcoholic fatty liver disease was first discovered in the 1970s by pathologists who noted that the
liver biopsies in such patients looked almost identical to the livers of diseased alcoholics.
It was detected in children in the mid-1980s. Now the disease is "highly prevalent" among both young
people and adults, according to the paper by Dr. Roberts and Dr. Diana Mager, a colleague at Sick
Kids, in the journal Clinics in Liver Disease.
Patients suffer an accumulation of excess fat in the liver. The exact cause is unclear, but experts
suspect metabolic syndrome, a cluster of disorders that also increases the risk of diabetes, heart
disease and stroke.
Early symptoms can include fatigue, malaise and a dull ache in the upper right abdomen, a possible
sign of an enlarged liver. It can lead to non-alcoholic steatohepatitis -- inflammation of the organ -- and
eventually to cirrhosis, where scarring impedes the liver's function and can bring on liver failure. Liver
cancer is also a possibility.
Even most untreated children who have fatty liver disease would not get to that stage, if at all, until
they are in their 30s. However, Dr. Roberts said she has counted at least a dozen cases of children
worldwide who have developed cirrhosis of the liver. One had to have a transplant. The paper notes
that children as young as four have been diagnosed with NAFLD.
"Doctors ... are seeing more and more kids with this problem," said Jai Terashita, a spokesman for the
Canadian Liver Foundation. "The trouble is that a lot of children have fatty liver disease but will not
realize it until their liver has severe damage in their adult lives ... If you get to that end stage, the only
thing you can do is put your name on that transplant list."
Mr. Williams first started seeing a doctor because of a strange rash on one side of his abdomen. He
visited a number of physicians over a year until finally blood tests indicated a possible liver problem.
The teenager went to Dr. Roberts, who diagnosed NAFLD.
At the time he was about 5-foot-7 and 180 pounds, giving him a body mass index of 28, with 25 to 30
being considered overweight and over 30 obese. Mr. Williams said his BMI is almost in the desired
range, and he is exercising more and eating better.
The rash eventually went away and is not considered linked to the condition. There were few outward
signs his liver was diseased.
"At times," he said, "I would feel a little unwell."