The Unfortunate Link Between Fatty Liver Disease and Latino Kids

Health professionals tend to think of fatty liver disease as a condition that affects middle-aged adults. However, with the proliferation of sugar-sweetened beverages and snacks in this dystopian era of food production — where Coca-Cola is cheaper (and in some places safer) than water, where breakfast consists of sugar-coated refined carbs and literal marshmallows — pediatric fatty liver disease is real. Recent findings suggest that the implications of this chronic and potentially life-threatening disease are of particular importance to the Latino community.

Whereas approximately 25 percent of the total U.S. population has fatty liver disease, the available data suggests that the condition is significantly more prevalent in Hispanic populations. One study cited by Scientific American found that the rate of fatty liver disease among a multiethnic group of adults in Dallas is upwards of 45 percent for Hispanics. Rohit Kohli, the chief of gastroenterology, hepatology, and nutrition at the University of Southern California and Children’s Hospital Los Angeles, told the publication that the disease is “ripping through the Latino community like a silent tsunami and especially affecting children.” It’s not just that more people of Hispanic origin are developing the disease; they’re also dying of it at an outsized rate. In 2016, Latinos accounted for over half of fatty liver disease deaths in the U.S. 

What is Fatty Liver Disease?

There are two types of fatty liver disease. One is caused by an overconsumption of alcohol over a long period of time. The one we’re talking about here is the type that is specified as nonalcoholic fatty liver disease. According to government data, about a quarter of the world’s population has nonalcoholic fatty liver disease, a number that is rising along with rates of other diseases tied to dietary habits such as obesity, type 2 diabetes, and high cholesterol. In the United States, nonalcoholic fatty liver disease is the most common chronic liver disorder among youth populations. There are currently about 7 million children who have the disease, according to a statistic cited by the New York Times earlier this year.

These figures are simply estimates, since the condition is a bit difficult to diagnose; many people who have fatty liver disease are asymptomatic, so there’s no indication to a health professional to screen for the disease, and MRI or a blood test. People with more advanced stages of the disease can experience symptoms of fatigue, jaundice, and pain and swelling in the abdomen. 

Fatty liver disease can manifest as “simple” fatty liver, in which the organ retains fat but does not typically lead to complications. A liver is considered “fatty” when it is composed of over 5 percent fat. (P.S.: If the name of the disease is reminiscent to you of foie gras, your instincts are on point: Foie gras, the classic culinary staple of an indulgent French meal — the translation for “foie gras” is “fatty liver” — is actually the goose version of fatty liver disease. It is, perhaps, a revelation that is equally as unappetizing as the practice of force-feeding these birds to induce this condition.) 

Why Are Latinos at Risk?

The short and perhaps best answer is genetics. People of Hispanic origin face an outsized chance of developing fatty liver disease because many — about half of all Hispanics and Latinos — carry a gene called PNPLA3 that raises their risk of disease significantly. Considering Hispanic youth are nearly twice as likely to be overweight as their non-Hispanic white peers, they are even more susceptible to developing the illness than other demographic groups because conditions like overweight and obesity can exacerbate any underlying risk that a child or teen has for fatty liver disease. It’s important to note, though, that the genetic component is the most influential risk factor for the condition. 

Left unchecked, fatty liver disease can progress into a more dangerous form called nonalcoholic steatohepatitis, which can lead to inflammation and irreversible damage to the liver. Ultimately, the liver can become so damaged — susceptible to cirrhosis and liver cancer — that it is no longer treatable and requires one to receive a liver transplant. Currently, there are about 14,000 people awaiting liver transplants; only half of the people on the waitlist requiring a transplant received one in 2016, and according to a 2018 report, we can expect longer wait times in the future due to “increasing demand on limited resources.”

Since the most serious complications of fatty liver disease tend to develop over time, it may seem premature to be concerned about the prospect of liver transplants when discussing pediatric fatty alcohol disease… but it’s not. “Cirrhosis — scarring of the liver due to chronic inflammation — is rare in kids, but it’s a concerning long-term consequence that can lead to end-stage liver disease,” pediatric gastroenterologist Jennifer Woo Baidal said in a Columbia University Irving Medical Center blog. “I’ve seen a child as young as 6 with inflammation and a teen with cirrhosis.” There’s no data available indicating how many young people have more advanced stages of the illness, but Baidal cited research that suggested that about 10 percent of children and teens suffer from any stage of fatty liver disease. 

What You Can Do to Protect Your Kids from Fatty Liver Disease

Reducing the amount of added sugars in one’s diet is one way to reduce the risk of developing a more serious case of fatty liver disease. A study from earlier this year found that overweight or obese teens diagnosed with fatty liver disease (most of whom were Hispanic) were able to shed fat from their livers as well as reduce inflammation levels in their livers simply by cutting out sugary foods and beverages over an eight-week period. They were only restricted on how much added sugar they could consume — meaning, aside from banishing sugary beverages and foods from their diets, they could continue eating what they liked. Simply cutting out sugars did not result in “cure” of the condition itself, but it did reduce the proportion of fat in their livers by an average of 31 percent and also contributed to a significant reduction in inflammation. “Unfortunately, that general recommendation [of cutting out sugar] hasn’t improved the disease as much as we would like, and there are no large randomized trials looking at which diet is the best one for fatty liver,” noted Miriam Vos, the lead author of the study, in an interview with the Times.

In addition to supporting health through diet, there are a couple other precautions you can take to reduce your child’s risk of fatty liver disease, including helping them to lose excess weight by encouraging regular physical activity through sports, exercise, and play. Another thing is to make sure your child is caught up with vaccinations; fatty liver disease can pose a mortal threat when the liver is compromised by hepatitis A or B, a dangerous combination of conditions that can put one at risk for liver failure. Hispanic people are 60 percent more likely to die from viral hepatitis than their white peers, so it’s especially critical for the Hispanic community to be vaccinated for both hepatitis A and B. 

In the meantime, experts simply suggest following basic tenets of healthy eating in order to reduce the risk of developing fatty liver disease — eat lots of vegetables and fruits, avoid processed and sugary foods and beverages, and opt for whole grains over refined carbs. The best way to implement this diet is to get the entire family on board in order to reinforce the healthy eating habits that will follow young children and adolescents into adulthood.