A large population suffers from fatty liver disease, which is also known as hepatic steatosis. It usually occurs when excess fat builds up in liver cells. It mostly affects adults, but when a rise in cases among children is alarming. Fatty liver disease in children is also known as pediatric non-alcoholic fatty liver disease (NAFLD). As it became a growing concern, WION spoke to experts to get valuable insights. 

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Dr Vittal Kumar Kesireddy, who is Consultant and In-Charge, Department of Paediatrics, CARE Hospitals, Banjara Hills, Hyderabad, told WION, "It affects almost 10 per cent of children in India as per today's guidelines. It occurs because of fat deposits in the liver causing inflammation and then causing liver damage." 

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What are the symptoms? 

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Symptoms are often asymptomatic; in some cases, fatigue, abdominal discomfort or pain and enlarged liver are observed. Patients with such condition have symptoms of "fatigue, shortness of breath and discomfort over the liver region over the abdomen," Dr Kesireddy said, further adding that mostly it is "genetic and environmental factors causing the liver disease". 

Dr Suresh Raghavaiah, HOD & Sr Consultant - HPB & GI Surgery, & Multi-organ Transplant Surgery, Gleneagles BGS Hospital Kengeri, Bengaluru, told WION, "In my previous decade of practice, fatty liver used to always be limited to, I would say, middle-aged and older age patients who were suffering from diabetes. But in the past two to three years, what I have seen is that teenagers at the youngest 20 years of age are coming with fatty liver disease." 

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Dr Raghavaiah, "The surge is due to what I call the 'Unholy Triad'. The FIRST one is high-calorie drinks and highly processed foods which are extremely rich in calorie. And the access to this is unbelievable right now. Within 10 minutes, you can order and have this thing on your tabletop." 

"The SECOND one is I think all the youngsters nowadays are leading a sedentary lifestyle. Everybody has a desk job and absolutely no option for physical exercise. And to burn off the calories they are consuming," Dr Raghavaiah added. 

"And the THIRD one, obviously, is the pub culture, I would say, of Bangalore. And I'm sure we all know that Bangalore has probably one of the highest density of pubs. And everybody drinks drinks in the weekends," Dr Raghavaiah said.

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What are the reasons and risk factors?

Genetic predisposition, obesity, insulin resistance, diabetes and high cholesterol are some of the major risk factors. Dr Kesireddy said that in genetics, there are nucleotide polymorphisms that are associated which go by genetic lineage. In the environmental factor, it's all because of high sugar intake causing insulin resistance and then leading to liver damage. Mostly fructose metabolism in the liver can lead to increased lipogenesis which leads to liver damage.

Dr Raghavaiah explained that when you eat high-calorie food and not have any exercise, it converts all these sugars to fat. And that's why we have fatty liver disease. Now the problem is if this is left untreated, the fatty liver disease leads to inflammation of the liver and then scarring of the liver. "And if this continues to progress, it will lead to cirrhosis of the liver. And unfortunately, it cannot be diagnosed early. And that is the pain of fatty liver disease unless we really look for it, for the fatty liver disease," Dr Raghavaiah said.  

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Children should stay away from packed fruit juices or other sugary items

Dr Kesireddy said that liver diese happen through packed fruit juices or other sugary items which we take in normal practices. He added, "A sedentary lifestyle is the biggest life risk factor for children who are not obese in 9 to 11 years." 

A case study...

Dr Raghavaiah explained a case he was treating. "A potential donor we saw, I think, as early as about three months back. He was a 22-year-old techie. He actually came forward to be a liver donor for his dad who needed a liver transplant. All of his blood tests, everything was normal and we were hopeful that he would be a good donor. But the moment we did an ultrasound, he was found to have a grade 2 fatty liver. 

This came as a huge surprise, not only for him and his family. But obviously, for his dad who was waiting for the transplant and was hoping that his son could donate. But this is the highlight that even young girls nowadays have fatty liver disease which is going unnoticed. But thankfully, we were able to counsel him and put him on a strict diet, calorie-restricted diet. 

Thankfully, we were able to counsel him and put him on a strict diet calorie-restricted diet what we call that and we counselled him to do physical exercise and give up alcohol I'm happy to say within about two months time the fatty liver had completely disappeared and even more happy to say that he went on to donate his liver to his dad and both the dad and the son are doing well." 

Regular screening is a must

Experts have said that initially screenings are done with the lipid profile, random blood sugar and ultrasound abdomen. They added that alkaline phosphatase levels and liver biopsy can confirm the diagnosis of liver disease in paediatrics. 

When it comes to treatment, and reversing of liver disease we do mostly by giving them a balanced diet chart and asking them to go for physical activities. These lifestyles can change the fat buildup so the inflammation comes down and it may not lead to permanent scarring in the liver. Adding supplements like vitamin E and omega-3 fatty acid-related foods and probiotics which improve gut health can improve the liver thing by not accumulating the toxic products in the liver thank you. 

Dr Raghavaiah said, "Simple changes in our lifestyle including you know avoiding unhealthy foods getting a bit of exercise I would say what's been prescribed with about 150 minutes of vigorous exercise a week is what is needed and avoiding alcohol and even if you can't avoid at least moderating your alcohol intake is going to go a long way in preventing fatty liver disease." 

Dr Raghavaiah said, There are a lot of medications, but in order to treat fatty liver disease but as the old saying goes prevention is always better than cure."