Fatty Liver (NAFLD)
"While in many cases we cannot cure NAFLD, we can keep it from progressing into something much more serious. The sooner we can start to work with families to control it, the better outcomes we can achieve."
Maureen Jonas, MD, director, Center for Childhood Liver Disease and senior associate in Gastroenterology and Nutrition
Non-alcoholic fatty liver disease, or NAFLD, is quite common – probably more so than we currently realize. But this frequency does not make it any less serious. Rather, NAFLD may be the first step on a path leading to serious liver complications, including cirrhosis.
Over the next few pages we will introduce you to the basics of NAFLD, its causes, signs and symptoms, and how the physicians in the Center for Childhood Liver Disease at Boston Children's Hospital care for children with NAFLD.
The liver is a large organ (the second largest in the body) responsible for processing nutrients from our food and medications in ways that allow the rest of the body to make use of them. It also acts as a big filter for the bloodstream, removing poisons and toxins as well as byproducts by our cells and tissues. The liver helps to control your blood sugar and your cholesterol, and it produces chemicals that help your blood to clot.
By virtue of all of its biochemical functions, it is normal for the liver to contain some fat. However, too much can lead to problems. If a child’s liver fat content rises to more than three percent of the organ’s total weight, doctors say that they have “fatty liver” or NAFLD. The increased fat content, or “steatosis,” in the liver’s cells causes it to swell and turn a yellowish color, very different from the organ’s normal reddish-brown hue.
NAFLD has close links with overweight and obesity, though certain medications and genetic factors can predispose a child to fat buildup in the liver. Because the association between NAFLD and obesity is so solid, some doctors recommend that all children and adolescents who are overweight or obese should be screened for NAFLD, usually by looking for increased levels of liver enzymes through a blood test.
As the liver struggles to process the excess fat, it can trigger an inflammatory response that can, in turn, cause greater damage. Should this happen, we say that the child has non-alcoholic steatohepatitis (NASH), which is a much more serious condition. The inflammation, if not checked, can cause the liver to start to scar – and severe scarring is the hallmark of cirrhosis. Eventually all of the liver’s healthy, soft tissue can be replaced with scar tissue.
For all of these reasons, the main treatment goal in NAFLD – primarily through weight loss, diet, exercise, and regular monitoring – is to prevent progression of the disease to NASH or cirrhosis.
How Boston Children's Hospital approaches NAFLD
There is no magic pill that will make NAFLD go away. Because it is a chronic disease, the physicians, nurses, and staff in the Center for Childhood Liver Disease work with families to make sure that they receive the resources, information, and support they need for the long term. Our specialists provide compassionate care that respects the values of each family and addresses their hopes and concerns for their child’s present and future health.