Indian children, obese and slim, are being hit by fatty liver disease

A recent survey of high school students in Delhi has found that over a fifth have non-alcoholic fatty liver disease (NAFLD) because they’re eating too much junk food and getting too little exercise.

NAFLD is the inflammation of the liver because of excessive fat deposits. It can lead to scarring of the liver, cirrhosis and eventually liver failure. The damage it does is similar to that caused by excessive consumption of alcohol.

In the early stages, corrective lifestyle changes can reverse the damage. But since the only symptom is abdominal pain, the percentage of non-alcoholic fatty liver disease cases that progress to cirrhosis is almost the same as the percentage in cases caused by alcohol in adults.

The study of Delhi students was conducted recently by Apollo hospitals and the Inclen trust. Of the 961 children aged 5 to 10 surveyed, from across 13 private schools, over 22% of the children in the normal weight range had non-alcoholic fatty liver disease. Of the overweight children, 45.6% had NAFLD.

The numbers for obese children are even higher. In a survey of 218 children 10- to 16-year-olds with a high body-mass index, 62.5% tested positive for NAFLD.

This study was led by Dr Vandana Jain, in charge of paediatric endocrinology at All India Institute of Medical Sciences, in 2016. “In fact, in our study of NAFLD in overweight children, we needed lean adults without NAFLD as controls; of the 128 lean adults evaluated, 34 actually had NAFLD and couldn’t be enrolled in the study,” she says.

Meanwhile, the number of Indian children fighting obesity is rising steadily — up from 16.3% between 2001 and 2005 to 19.3% in 2010, according to a 2016 analysis of 52 studies conducted in 16 Indian states and published in The Indian Journal of Medical Research.

BATTLE OF THE BULGE

In non-obese children, a warning sign to watch out for is excessive central fat in the waist and abdominal region.

“This central obesity is often associated with ectopic fat deposits (storage of triglycerides in tissues other than adipose that is meant to store fat) in the liver,” says Dr Jain.

High waist circumference and waist-to-hip ratio are markers for children at risk. “A handy tip: waist circumference should ideally be less than half of a person’s height,” Dr Jain says.

Unexplained fatigue can be a symptom too, says Dr Ameet Mandot, consultant, gastroenterology at Mumbai’s SL Raheja (Fortis) Hospital.

Four years ago, he started treating an 11-year-old who had persistent abdominal pains.

“An ultrasound test detected abnormal fat deposits in his liver. He had a BMI of 22 and was not overweight, but had a very sedentary lifestyle with hardly any outdoor sports in his routine,” Dr Mandot says.

He prescribed a regular 40 minutes of exercise a day, more vegetables and fibre, less fried and fatty foods. “In a year, the fat in his liver was down to less than 10%,” Dr Mandot says.

QUICK FIX

NAFLD is a lifestyle disease, so the best way to control and even reverse it is to fix what’s wrong with the child’s lifestyle. “Avoid sugary beverages, including juices and glucose drinks,” says Dr Jain. “Enforce a diet where most meals are balanced, home-cooked fare. And lead by example when it comes to physical activity.”

Sadly, the fact that it is a lifestyle disease also makes it hard to treat. There is no pill to pop for NAFLD. No obvious signs that it’s getting worse.

“It’s a challenge for a doctor to treat a child with the condition as it requires dietary restrictions and a lifestyle change — and that has to start at home,” says Dr Ashmita Mahajan, consultant pediatrician at Mumbai’s SL Raheja Hospital. “The empty calories have to be cut; candy, chocolate, meat and fries removed from the diet.”

The easier way out, says Dr Jain, is to encourage healthy eating and physical activity from early childhood.