Liver Health Takes a Hit in Young Overweight Children

Veronica Hackethal, MD

April 05, 2018

Children who are overweight or obese in early childhood are at increased risk of developing signs of nonalcoholic fatty liver disease (NAFLD) as early as age 8 years, according to a study published online April 4 in the Journal of Pediatrics.

The study is the first to link overweight/obesity in early childhood to negative effects on liver health beginning as early as midchildhood.

"With the rise in childhood obesity, we are seeing more kids with nonalcoholic fatty liver disease in our pediatric weight management practice," Jennifer Woo Baidal, MD, MPH, from Columbia University Vagelos College of Physicians and Surgeons, New York City, said in a news release.

"Many parents know that obesity can lead to type 2 diabetes and other metabolic conditions, but there is far less awareness that obesity, even in young children, can lead to serious liver disease," she added.

About 10% of children and adolescents in the United States now have NAFLD, a condition in which fat accumulates in the liver and interferes with function. Although usually symptomless, NAFLD can set children up for further health problems down the road, including liver cirrhosis and liver cancer. Risk factors for NAFLD in children include being overweight/obese, older age, Asian ancestry, Hispanic/Latino ethnicity, and male sex.

Studies have looked at the effect of overweight/obesity in NAFLD in older children and teenagers; however, few studies have looked at the issue in early childhood.

To see how overweight/obesity in early childhood affects NAFLD later in childhood, researchers evaluated 635 children from the prospective Project Viva study in Massachusetts. Participants were 48% girls, 59% white, 21% black, 6% Hispanic/Latino, and 3% Asian.

Researchers measured weight, height, skinfold thickness, and waist-to-hip circumference at about age 3 years, and then again at age 8 years. They also measured blood levels of alanine aminotransferase (ALT), which they considered a surrogate for NAFLD. Some experts have recommended measuring ALT levels as a way to screen for NAFLD in children at risk for it. Studies in adolescents have linked elevated ALT levels to insulin resistance and metabolic dysfunction.

Results showed that 29% of 3-year-old children were overweight or obese.

Overall, 23% of 8-year-olds had elevated ALT levels; rates varied according to whether they were overweight or obese. ALT levels were elevated in 22.5% of obese 8-year-olds compared with 12.5% of those with normal weight.

Elevated ALT in midchildhood was also associated with higher levels of insulin resistance, which was only partly accounted for by increased body mass index.

Analyses adjusted for various confounders including race/ethnicity and household income suggested that for each additional 10-cm increase in waist circumference at age 3 years, the odds of having elevated ALT at age 8 years almost doubled (odds ratio, 1.99; 95% confidence interval, 1.19 - 3.33).

On the basis of these results, the authors propose routinely measuring waist circumference to assess risk for diabetes and liver and heart disease in children. Increased waist circumference has been associated with increased risk for chronic health problems such as diabetes and heart disease.

They also suggest clinicians should target early childhood for preventing pediatric obesity, liver disease, and metabolic disorders.

"Some clinicians measure ALT levels in at-risk children starting at around 10 years old, but our findings underscore the importance of acting earlier in a child's life to prevent excess weight gain and subsequent liver inflammation," Baidal said in the news release.

"Currently, the best way for kids and adults to combat fatty liver disease is to lose weight, by eating fewer processed foods and getting regular exercise. We urgently need better ways to screen, diagnose, prevent, and treat this disease starting in childhood."

The study was supported by the National Institutes of Health and the Robert Wood Johnson Foundation. The authors have disclosed no relevant financial relationships.

J Pediatrics. Published online April 4, 2018. Full text

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