Earlier this year I wrote about the sobering fact that up to 10% of children in the USA are estimated to be living with NAFLD, with nearly a quarter of them having progressed to NASH. It’s bad enough that millions of children are having to face this disease so early in life but the evidence is actually getting worse for pre-teen children, as research has shown that fatty liver disease progression through NASH to fibrosis and eventual liver failure is significantly accelerated versus the teen or adult population.
The research is still unclear on precisely why pre-teens are more at risk for developing serious NASH. It may have to do with the fact that the liver is undergoing such major growth and development during these years. Studies have been leaning towards this conclusion for several years, but nearly all of the recent research has been fairly definitive.
“We concluded in this study that NASH is more severe in younger children compared to adolescents and this is independent to any difference in gender, obesity, ethnicity, BMI z-score and waist-to-circumference percentile,” Rehan Abdou, MD, University at Buffalo
I recently spoke with a panel of distinguished liver experts who all confirmed that they are seeing dramatic increases in NAFLD/NASH with younger children in their practices. Several gave examples of their most severe NASH cases, where children as young as eight years old are getting liver transplants to replace completely cirrhotic livers.
The good news is that the survival rate for younger children that receive transplants is very good, and only improving. The bad news is that the rate of new pediatric cases is increasing rapidly, outpacing even the rate of obesity in children. That suggests this number will continue to rise.
In adults, the rising prevalence of fatty liver has mirrored the increase in obesity. But in children, fatty liver is increasing at a rate “faster and above” the increase in childhood obesity. That suggests that there’s something else going on. We don’t know, but some of the research has shown there may be early exposures in pregnancy or diet exposures that could be helping to drive this.” ” Dr. Miriam Vos, Children’s Healthcare of Atlanta.
One area that nearly all childhood obesity research has focused on for quite some time is sugary drinks. Recent studies have shown that the 30% of children consume more than two sugary drinks a day. 70% have at least one. There is a very strong correlation between the regular consumption of sugary drinks and weight gain, which leads downstream to all sorts of issues aside from NAFLD/NASH.
Many studies have shown eliminating sugary drinks can lead to reduction in weight gain (and interestingly, seemed to have an ever greater impact on the Hispanic population, which is one of the hardest hit in the NASH epidemic). And the government is starting to take notice. Earlier this year, Baltimore became the first city in the nation to ban sugary sodas from their children’s menus.
It is not just sodas that are bad for children. A huge portion of the sugary drink market is sport drinks and juice. Yes, juice. Most people do not realize that even 100% all-natural juice contains a boat-load of sugar. Yet a single glass of 100% orange juice contains roughly the same amount of sugar as a can of soda. And young children drink tons of juice.
More than half of preschool-age children (ages 2 to 5) drink juice regularly, a proportion that, unlike for sodas, has not budged in recent decades. These children consume on average 10 ounces per day, more than twice the amount recommended by the American Academy of Pediatrics.
Research also suggests that children that drink juice regularly will go on to continue to drink other sugary drinks at higher rates than preschool children that do not regularly drink juice.
I tend to focus on NASH in adults with this blog, as all of my own research and interest stems from my Mom, but I’m also a father of a young child myself. As I continue to learn more about NASH and all of the interconnections with obesity and liver health, I am constantly surprised at what I discover. Parents everywhere need to be informed to these risks.