Non-alcoholic fatty liver disease (NAFLD) is a condition in which fat builds up in the liver. There is normally a small amount of fat in liver cells; however, when a significant amount of fat builds up liver disease can follow. Non-alcoholic fatty liver disease has been increasing in both adults and children over recent decades and has now become the most common form of chronic liver disease in children. The condition usually progresses slowly over decades and only a few children have serious medical problems in early life. Health professionals are still learning about the condition but believe that early recognition and treatment of the condition is important as serious liver problems can develop in early adulthood including cirrhosis and liver cancer.
*This website provides general information but does not replace medical advice. It is important to contact your/your child’s medical team if you have any worries or concerns
Insulin is a hormone released by the pancreas which acts on muscle as well as fat cells. It has an important role in controlling sugar levels and food and energy balance in the body. In some people muscle and fat cells stop responding to insulin and the pancreas releases increasing amounts of insulin. The liver is then bombarded by insulin, allowing more fat into the liver cell and decreasing the amount of fat processed and released from the liver cell. People who are prone to insulin resistance and NAFLD tend to deposit fat around their abdomens and around the organs within the abdominal cavity, thus worsening the amount of fat in and around the liver. In some children and adults with fatty liver disease, for reasons that we do not yet understand, the liver can become irritated and fat can cause inflammation and lead to liver scarring.
- Children and young people often go to their GP with abdominal pain and undergo routine liver function tests and an ultrasound scan which turns out to be abnormal
- An enlarged liver and/or an enlarged spleen may be found on routine examination
- On blood testing for other reasons when abnormal liver function tests are found
- If your child is undergoing investigations for type 2 diabetes or for overweight, liver function tests and an ultrasound are often part of the screening
- To find out to what extent the child is affected by the fat in the liver. Children may have inflammation and scarring in their liver alongside their fat
- To make sure that no other liver disease is present which will need other types of treatment
- To look for other health issues which are known to be associated with fatty liver e.g. high blood pressure, early signs of diabetes
At least one and often several members of the team will discuss with you about your child’s past growth, development, lifestyle and health. This will be specifically looking for factors that may have contributed to the condition. An estimate of Body Mass Index (BMI) will be made. This uses height and weight readings and can be compared to expected values at various ages.
A range of tests may include some or all of the following:
- Blood tests
- Urine tests
- Oral Glucose Tolerance Test – a test looking for insulin resistance and type 2 diabetes which are closely associated with non-alcoholic fatty liver disease
- Liver biopsy – a procedure in which a small sample of liver tissue is obtained by passing a specially designed needle through the skin
Non-alcoholic steatohepatitis (NASH) is inflammation of the liver associated with accumulation of fat. It is often associated with a degree of scarring in the liver called fibrosis. About a third of children with fat in their liver are thought to go on to develop NASH.
Fat, inflammation and scarring in non-alcoholic fatty liver disease are generally considered to be fully reversible in most cases. Treatment involves decreasing the amount of fat that gathers in the liver cells and thus the inflammation and scarring that accompanies it. All children, whether overweight or not, should be assessed by the dietitian and given advice about weight management including healthy eating. Activity levels and general fitness need to be increased. Reversing the build-up of fat in the liver can take months or even years but is critical to treating the condition.
For those with significant insulin resistance, lifestyle measures are the first port of call. They may be asked to remain the same weight as they grow in height or alternatively lose a certain percentage of body weight according to their age and developmental stage. Specific advice and treatment may be given to children when they are known to complications of cirrhosis.