About non-alcoholic fatty liver disease (NAFLD)
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 but when a significant amount builds up liver disease can follow.
NAFLD 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.
Health professionals are still learning about NAFLD but believe that early recognition and treatment is important, as serious liver problems can develop in early adulthood including cirrhosis and liver cancer.
What causes NAFLD?
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.
Why might NAFLD be suspected in a young person?
- Children and young people often present to their GP with abdominal pain and undergo routine liver function tests (blood tests) and an ultrasound scan which turn out to be abnormal
- An enlarged liver and/or an enlarged spleen may be found on routine examination
- On blood testing for other reasons and 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 screen.
Why do young people with suspected NAFLD need to be investigated?
- To find out to what extent the child or young person is affected by the fat in their liver.
- 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
What investigations are needed?
Clinical Examinations and History Taking
This involves at least one and often several members of the team discussing with you about a 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 (OGTT) - this is a test looking for insulin resistance and type 2 diabetes which are closely associated with NAFLD.
- Liver Biopsy - this is a procedure in which a small sample of liver tissue is obtained by passing a specially designed needle though the skin.
This means inflammation of the liver associated with accumulation of fat and is often associated with a degree of scarring called fibrosis. About a third of those with fat in their liver are thought to go on to develop NASH.
Treatment options for NAFLD
Treatment involves decreasing the amount of fat that gathers in the liver cells and the inflammation and scarring that accompanies it. All children and young people, whether overweight or not, should be assessed by the dietitian and advice given about weight management to include healthy eating.
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. Young people should also avoid other stresses to the body and the liver such as taking excess alcohol and smoking.
Specific advice and treatment may be given to children when they are known to have complications of cirrhosis.
Children with NAFLD do not appear to have permanent damage to the liver, but as yet we do not know enough about the condition to predict who may go on to have inflammation and damage in the future.
Want to know more about NAFLD? Download CLDF’s leaflet on non-alcoholic fatty liver disease.
You can also order a copy of the leaflet here
The information on this site is for guidance only. It is not a substitute for professional medical care by a qualified doctor or other health care professional. ALWAYS check with your medical team if you have any concerns about your condition or treatment. CLDF is not responsible or liable, directly or indirectly, for any form of damages resulting from the use (or misuse) of information contained in or implied by the information on this site.