Don’t Shy Away from Addressing Elevated Liver Enzymes in Children
Ruth McDonald, MD
Vice President, Associate Chief Medical Officer, Seattle Children’s
Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common cause of chronic liver disease in American children. Though still underdiagnosed, it is estimated that more than 10% of the U.S. pediatric population – and nearly 40% of this population that is clinically obese – have NAFLD. Untreated, NAFLD causes the same damage to the liver as chronic alcohol use.
NAFLD is completely preventable, and if caught in time, completely reversible. Because the disease is often asymptomatic for many years it is important to screen for fatty liver by obtaining liver enzymes when risk factors are present.
The primary risk factor is obesity. Other factors to consider:
- Family history of fatty liver disease
- Increased waist circumference
- Genetic predisposition – NAFLD is more common in certain ethnic groups, with Hispanic children having the highest prevalence
- Boys are 40% more likely than girls to have steatosis
- Metabolic syndrome disorders – hypertension, cholesterol abnormalities, diabetes, etc. (often related to obesity)
Every child with elevated liver enzymes (ALT above 50) should be evaluated by a pediatric hepatologist to determine what exactly is causing the inflammation. While NAFLD is the most common cause of chronic liver disease in children, there are other causes of elevated liver enzymes that should be ruled out.
Most effective treatment: Healthy eating and exercise
Studies have found that neither vitamin C, fish oil, probiotics, lipid lowering agents, nor ursodeoxycholic acid lower liver enzymes or improve histology.
Weight loss and dietary intervention that normalize carbohydrate and sugar intake are the most effective approach to treating NAFLD, though they require behavior change from the entire family – the patient needs to be motivated and the family needs to be committed.
Managing in the primary care setting is possible, but can require multiple appointments to move the patient and family to readiness, and then to manage the progress over time.
Seattle Children’s offers a multidisciplinary program dedicated to diagnosing, treating, and managing fatty liver disease in children and adolescents, and recently opened the Insulin Resistant Fatty Liver Clinic that combines endocrinology and hepatology.