Chil­dren are be­ing di­ag­nosed with fatty liver dis­ease, a re­sult of too much junk food and too lit­tle ex­er­cise. Of­ten, there are no symp­toms. In ad­vanced stages, dam­age is sim­i­lar to that caused by ex­ces­sive al­co­hol

Hindustan Times (Lucknow) - - Think - Anonna Dutt & Di­pan­jan Sinha ▪

Are­cent sur­vey of high school stu­dents in Delhi has found that over a fifth have non-al­co­holic fatty liver dis­ease (NAFLD) be­cause they’re eat­ing too much junk food and get­ting too lit­tle ex­er­cise. NAFLD is the in­flam­ma­tion of the liver be­cause of ex­ces­sive fat de­posits. It can lead to scar­ring of the liver, cir­rho­sis and liver fail­ure. The dam­age it does is sim­i­lar to that caused by ex­ces­sive con­sump­tion of al­co­hol.

In the early stages, cor­rec­tive life­style changes can re­verse the dam­age. But since the only symp­tom is ab­dom­i­nal pain, the per­cent­age of non-al­co­holic fatty liver dis­ease cases that progress to cir­rho­sis is al­most the same as the per­cent­age in cases caused by al­co­hol in adults.

The study of Delhi stu­dents was con­ducted re­cently by Apollo hos­pi­tals and the In­clen trust. Of the 961 chil­dren aged 5 to 10 sur­veyed, from across 13 pri­vate schools, over 22% of the chil­dren in the nor­mal weight range had non-al­co­holic fatty liver dis­ease. Of the over­weight chil­dren, 45.6% had NAFLD.

The num­bers for obese chil­dren are even higher. In a sur­vey of 218 chil­dren aged 10 to 16 with a high body-mass in­dex, 62.5% tested pos­i­tive for NAFLD.

This study was led by Dr Van­dana Jain, in charge of pae­di­atric en­docrinol­ogy at All In­dia In­sti­tute of Med­i­cal Sciences, in 2016. “In fact, in our study of NAFLD in over­weight chil­dren, we needed lean adults with­out NAFLD as con­trols; of the 128 lean adults eval­u­ated, 34 ac­tu­ally had NAFLD and couldn’t be en­rolled in the study,” she says.

Mean­while, the num­ber of In­dian chil­dren fight­ing obe­sity is ris­ing steadily — up from 16.3% be­tween 2001 and 2005 to 19.3% in 2010, ac­cord­ing to a 2016 anal­y­sis of 52 stud­ies con­ducted in 16 In­dian states and pub­lished in The In­dian Jour­nal of Med­i­cal Re­search.


In non-obese chil­dren, a warn­ing sign to watch out for is ex­ces­sive cen­tral fat in the waist and ab­dom­i­nal re­gion.

“This cen­tral obe­sity is of­ten as­so­ci­ated with ec­topic fat de­posits [stor­age of triglyc­erides in tis­sues other than adi­pose that is meant to store fat] in the liver,” says Dr Jain.

High waist cir­cum­fer­ence and waist-to­hip ra­tio are mark­ers for chil­dren at risk.

“A handy tip: waist cir­cum­fer­ence

should ide­ally be less than half of a per­son’s height,” Dr Jain says.

Un­ex­plained fa­tigue can be a symp­tom too, says Dr Ameet Man­dot, con­sul­tant, gas­troen­terol­ogy at Mum­bai’s SL Ra­heja (For­tis) Hospi­tal. Four years ago, he started treat­ing an 11-year-old who had per­sis­tent ab­dom­i­nal pains.

“An ul­tra­sound test de­tected ab­nor­mal fat de­posits in his liver. He had a BMI of 22 and was not over­weight, but had a very seden­tary life­style with hardly any out­door sports in his rou­tine,” Dr Man­dot says.

He pre­scribed a reg­u­lar 40 min­utes of ex­er­cise a day, more veg­eta­bles and fi­bre, less fried and fatty foods. “In a year, the fat in his liver was down to less than 10%,” Dr Man­dot says.


NAFLD is a life­style dis­ease, so the best

way to con­trol and even re­verse it is to fix what’s wrong with the child’s life­style. “Avoid sug­ary bev­er­ages, in­clud­ing juices and glu­cose drinks,” says Dr Jain. En­force a diet where most meals are bal­anced, home-cooked fare. And lead by ex­am­ple when it comes to phys­i­cal ac­tiv­ity.”

Sadly, the fact that it is a life­style dis­ease also makes it hard to treat. There is no pill to pop for NAFLD. No ob­vi­ous signs that it’s get­ting worse.

“It’s a challenge for a doc­tor to treat a child with the con­di­tion as it re­quires di­etary re­stric­tions and a life­style change — and that has to start at home,” says Dr Ash­mita Ma­ha­jan, con­sul­tant pae­di­a­tri­cian at Mum­bai’s SL Ra­heja Hospi­tal. “The empty calo­ries have to be cut; candy, choco­late, meat and fries re­moved from the diet.”

The eas­ier way out, says Dr Jain, is to en­cour­age healthy eat­ing and phys­i­cal ac­tiv­ity from early child­hood.


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