Nonalcoholic Fatty Liver Disease (NAFLD) Clinic at Phoenix Children's Hospital
Nonalcoholic Fatty Liver Disease (NAFLD) or “fatty liver” happens slowly over time. It starts when fat builds up in the liver. After a while, the fats stay inside the liver, which causes inflammation and scarring, also called Non-Alcoholic SteatoHepatitis (NASH).
Progression of the disease may lead to end-stage liver disease, cirrhosis and liver cancer. It is estimated that in the year 2020, NAFLD will be the leading indication for liver transplant in adults.
NAFLD is usually caused by obesity in children or teens, unrelated to alcohol consumption. It frequently occurs with pre-diabetes, insulin resistance, diabetes or hypertension. It is often associated with the "metabolic syndrome." NAFLD also increases the chances of heart attacks and strokes. It is documented that children with fatty liver have other obesity-related medical conditions and have decreased quality of life.
Other symptoms and causes may include diabetes type 2, elevated cholesterol and triglycerides, abnormal periods in girls, hypertension, obstructive sleep apnea, headaches, abdominal pain, gall stones and orthopaedic complications.
NAFLD is becoming increasingly prevalent in children. It's estimated that five - 10 children out of 100 will develop NAFLD. Boys are 40 percent more likely to develop the disease, and it effects Hispanic and Native American children more than other races.
NAFLD is a diagnosis of exclusion and based on history, physical exam, laboratory testing, images and biopsies.
The patient is often overweight (the Body Mass Index, BMI is above the 85th percentile for age and gender) or obese (BMI above the 95th percentile). Often they have darkening of the skin in the neck and armpits, also called acanthosis nigricans.
Tests to diagnose NAFLD may include:
- Blood tests (liver enzymes): to see if there is liver damage and to rule out other causes of your child’s liver problems. Usually, the liver enzymes that are elevated included ALT, AST and GGT.
- Ultrasound or MRI: to look for fat or other abnormalities in the liver
- Liver biopsy: may be used for diagnosis to stage and grade NAFLD or to rule out other causes of liver disease.
The key element to treat fatty liver is a healthy lifestyle. That includes a healthy diet and increasing physical activity.
These goals can be best achieved if the whole family is engaged. There are some medical interventions including Metformin (insulin sensitizer), and antioxidants such as vitamin E and fish oil that have shown some benefit in reducing the damage caused by the fat in the liver.
NAFLD at Phoenix Children's Hospital
Phoenix Children's Hospital offers a compressive management of fatty liver. This includes a multidisciplinary team built of physicians, nutritionists and psychologists and the CARE Clinic. We follow the patients over time because managing NAFLD is a life-long challenge. In selective cases, we refer patients to see endocrinology, pulmonology, neurology, nephrology or cardiology, depending on their associated conditions.