Soaring rates of nonalcoholic fatty liver disease in children — which more than doubled from 2017 to 2021 in those ages 0 to 17 — have stressed the already wobbly United States health care system, The Washington Post reported in an extensive investigation.
“The medical community is scrambling to understand its epidemiology, risk factors, screening, diagnosis and management,” Ariana Eunjung Cha wrote, noting the Food and Drug Administration has not approved any treatments and that promising drugs are cost-prohibitive and often not covered by health insurance.
Like other diseases such as high blood pressure, high cholesterol, diabetes, and gallstones, nonalcoholic fatty liver disease was generally limited to adults.
That was until two decades ago. Now, as many as 5% to 10% of American children may have it, figures on par with asthma, according to the Post. Hospitalizations related to the disease and liver transplants have also risen sharply since 2017, and the incidence of the disease is up at least 28.4% across each age group.
Cha pointed to childhood meals that changed radically from the early 1980s to recent years, when 67% of energy came from the consumption of ultraprocesssed foods.
“It creates a time bomb, and it is killing our kids,” Barry M. Popkin, a nutrition professor at the University of North Carolina at Chapel Hill Gillings School of Global Public Health, told the Post.
The disease is not well understood — the Post reported that in a June study, scientists from 56 countries recommended changing the name to metabolic dysfunction-associated steatotic liver disease to avoid stigmatization and improve awareness and patient identification.
Problems may begin in utero, according to the Post. The development of nonalcoholic fatty liver disease in children has been linked to mothers with obesity and who consume large quantities of diet soda and junk food. New infant formulas with corn syrup solids instead of natural lactose may also contribute to the issue.
Why is this important?
Dani Rivera, one of the people with nonalcoholic fatty liver disease chronicled by the Post, was diagnosed as an eight-year-old in 2010. She had no symptoms.
“It took me a while to understand what was happening, and then I was really scared,” her mother, Carmen Hurtado, told the Post.
Doctors can prescribe diet and exercise but not much else, according to Cha, who noted “no treatment appears imminent” despite recent research investments.
She wrote that the “anti-fat craze” of the 1980s and ’90s “marked the ascendancy of artificial substitutes” and “altered how food is dealt with in the large intestine, a few studies suggested, potentially failing to trigger bacteria that live there and are essential to health, and thus changing in potentially negative ways our microbiomes — the community of microorganisms that exist in the gut and play a role in mood, cognition and disease.”
What’s being done?
A 2022 study showed a rise in noncommunicable diseases parallel to the rise in readily available processed foods, including sugar, refined flour and rice, and vegetable oils. The replacement of animal fats with processed and ultraprocessed foods was of particular concern.
Another study — of bottlenose dolphins — showed higher levels of pentadecanoic acid, or C15:0, which is found in fish, plants, milk, and butter, were linked to lower levels of liver fat.
So, even if the medical community is struggling to catch up, it seems clear that this is one result of changing dietary habits.
“Industry plays a huge role in promoting consumption and ease of access to junk foods,” Paula Hertel, a pediatric hepatologist at Texas Children’s Hospital, told the Post. “Some of the most unhealthy foods are the cheapest and easiest to gain access to.”
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