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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.
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.
Last 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."
On the Net:
NIH on fatty liver disease:
American Liver Foundation:
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