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From: Maureen on 7 Sep 2008 19:29
http://www.msnbc.msn.com/id/26529310

Heavy teens run risk of severe liver damage
Although disease is becoming more common in obese kids, few are tested
The Associated Press
updated 12:07 p.m. MT, Sun., Sept. 7, 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 Denver.

Few given necessary test
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 African-Americans, 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. JosDe
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.

'There aren't enough livers to go around'
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-San Francisco 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, 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
Guadelupe Shaffino, a restaurant cook.

UCSF Children's Hospital, with money from a state health program, agreed to
do the transplant. 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 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's 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 at the start of August.


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.

'More commonplace'
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."

Like heart disease, liver disease is silent. Kids may feel fine for years.
Any early symptoms, like fatigue and loss of appetite, are vague and
usually eclipsed by more conspicuous problems, from diabetes to high blood
pressure.

"The majority of children with this still go undiagnosed," said Dr. Jeffrey
Schwimmer, head of the Fatty Liver Clinic at Rady Children's Hospital in
San Diego. "Some kids have died."

The number of patients at his clinic has roughly tripled over its six
years, and he's seen one with cirrhosis just 8 years old.

"Many of these children, their parents have it (fatty liver disease) and
don't know it," said Schwimmer.

Early intervention is key
Experts say the best way to combat the problem is to intervene early, while
it can still be reversed, with a medical team working with the whole
family, including liver and hormone specialists, a dietitian and
counselors.

This spring, the American Academy of Pediatrics recommended doctors do a
blood test of liver enzymes every two years on obese children and
overweight ones with high blood pressure or cholesterol or family history
of heart disease. A trade group for children's hospitals last year gave
similar advice.

Within the last several months, there's been an explosion of research
published on it and the role genes may play.

Surprisingly, some research comes from countries not known for high obesity
rates: China, India and Iran. More reports come from Australia, England,
Greece, Ireland, Israel, Italy and Japan. Doctors say globalization has
given even poor countries fast food chains and sedentary pastimes: TV,
Internet, video games.

Scientists now are seeking the best ways to treat it.

A small study in Rome showed weight loss helped. The U.S. government is
testing the diabetes drug metformin and vitamin E and is funding about 20
other studies, including one that aims to determine how the disease
progresses and who is most likely to develop cirrhosis or liver failure.

When her son was diagnosed with advanced liver disease three years ago,
Susan Siegfried recalls being "devastated." Curtis, then 12, was just over
5-feet-5 and weighed 179 pounds. About 40 percent of his liver was scarred.

Her husband, Mike, decreed the whole family would change its diet, and all
high-fat and junk food was removed from their home in Chester, Ill.

Susan Siegfried said her son went from being the "sit-in-front-of-the-TV,
play-video-games kind of kid," tired and sickly, to full of energy and very
active. He now bales hay and does other chores on his uncles' nearby farm.
Initially, he dropped about 20 pounds. He's shot up 4 inches but only
gained 8 pounds in the past two years.

A new liver biopsy last fall showed huge improvement in his liver.

"I'm definitely a lot thinner than I would have been if I hadn't done
anything," said Curtis, who found exercising and cutting out sugar and fat
wasn't that hard. "If you stick with it, you'll get used to it."



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