- The Washington Times - Monday, September 8, 2008

TRENTON, N.J. | In a new and disturbing twist on the obesity epidemic, some overweight teenagers have severe liver damage caused by too much body fat, and a handful have needed liver transplants.

Many more may need a new liver by their 30s or 40s, say experts warning that pediatricians need to be more vigilant.

The condition, which can lead to cirrhosis and liver failure or liver cancer, is being seen in kids in the United States, Europe, Australia and even some developing countries, according to a surge of recent medical studies and doctors interviewed by the Associated Press.

The American Liver Foundation and other experts estimate 2 percent to 5 percent of American children over age 5, nearly all of them obese or overweight, have the condition, called nonalcoholic fatty liver disease.

“It’s clearly the most common cause of liver disease,” said Dr. Ronald Sokol, head of public policy at the liver foundation and a liver specialist at Children’s Hospital and University of Colorado at Denver.

Some experts think as many as 10 percent of all children and half of those who are obese may suffer from it, but note that few are given the simple blood test that can signal its presence. A biopsy is the only sure way to diagnose this disease.

As fat builds up, the liver can become inflamed and then scarred over time, leading to cirrhosis, a serious condition, which in years past was mostly caused by hepatitis or drinking too much alcohol. Liver failure or liver cancer can follow, but if cirrhosis has not yet developed, fatty liver disease can be reversed through weight loss.

The disease is most common in overweight children with belly fat and certain warning signs, such as diabetes or cholesterol or heart problems. However, it’s been seen in a few children of normal weight.

Genetics, diet and exercise level all play a role. It is most prevalent among Hispanics, relatively rare among blacks, and more common among boys than girls.

“There are people in their 30s or early 40s that will require a liver transplant” from developing the condition as a kid, predicts Dr. Jose Derdoy, head of liver transplants at Cardinal Glennon Children’s Medical Center in St. Louis. He’s treated a 15-year-old, 530-pound boy and many others with the condition.

Experts blame obesity, with about two-thirds of all Americans overweight. With fatty liver disease becoming more common in adults, many experts predict it will become the top cause of liver transplants by 2020.

“There aren’t enough livers to go around,” says Dr. Philip Rosenthal of the University of California at San Francisco (UCSF) Children’s Hospital.

His patient, Irving Shaffino, a 15-year-old Mexican-American who lives outside Lubbock, Texas, was lucky to get a transplant a year ago. He was in end-stage cirrhosis and, at 5-feet-4 1/2, weighed 180 pounds.

Irving had been fat since age 6, thanks to a high-starch, high-fat diet of Mexican food, pizza and burgers, said his mother, Guadelupe Shaffino. At age 8, she said, he had a distended stomach and by his early teens, breathing problems kept him tethered to an oxygen tank at home.

Without health insurance, the family couldn’t find a local hospital that would do a transplant.

“My son begged me, ‘Don’t let me die, Mommy,’ so I did everything in my power to find a place to help him. Thanks be to God, we found a way,” said Ms. Shaffino, a restaurant cook.

UCSF Children’s Hospital, with money from a state health program, agreed to do the transplant. Dr. Rosenthal, who oversees the hospital’s pediatric liver transplant program, took over care of Irving. The doctor said without a new liver Irving would have died, maybe within months.

“He was in bad shape,” said Dr. Rosenthal.

Soon after tests were completed and Irving got on a transplant waiting list, an organ was found.

“It felt like a miracle, because people say you could be on the transplant list for years,” Irving said.

Within a couple of months of the July 26, 2007, operation, Irving had weaned himself from the oxygen tank and could go on walks, although he got winded quickly.

Back home in Texas, his medications are down from 11 to four and Irving said he has replaced soda and fast food with fruit, vegetables and whole grains.

“I want to get into sports again,” he said. “I want to get down to maybe 150” pounds.

Sadly, however, Irving has made little progress in losing weight. While he’s grown an inch and a half since his operation, he’s still obese, and his weight was up to 219 last month.

Specialists say many kids diagnosed with fatty liver disease come to subsequent checkups heavier, and at best, just one in four loses significant weight, the only treatment known to stop and even reverse the disease.

“My patients that are successful, the whole family has bought in,” increasing exercise and changing diet, said Dr. Stephanie Abrams, a liver and obesity specialist at Texas Children’s Hospital. “The problem is that we aren’t changing society in favor of becoming lean.”

The scope of the disease has only been realized in recent years. Just a handful of cases were reported in medical journals in the 1980s, and in the past, many adult patients were thought to be lying when they denied drinking alcohol.

Only three liver transplants on American children with nonalcoholic fatty liver disease were recorded from 1990 through 2002; two were done last year.

“It really has been only in the last two or three years that this has become more commonplace,” said Dr. Ann Scheimann, a pediatric gastroenterologist at Johns Hopkins Children’s Center. “It is scary.”

Copyright © 2018 The Washington Times, LLC. Click here for reprint permission.

The Washington Times Comment Policy

The Washington Times is switching its third-party commenting system from Disqus to Spot.IM. You will need to either create an account with Spot.im or if you wish to use your Disqus account look under the Conversation for the link "Have a Disqus Account?". Please read our Comment Policy before commenting.


Click to Read More and View Comments

Click to Hide