Saturday, October 2, 2010

Non-alcoholic Fatty Liver Disease in Kids

A disturbing conversation

While I was in the University Health Center for some routine blood work yesterday, I learned something interesting.

The doctor I talked with happened to be a national speaker on diabetes, which lead us in to a conversation on the nutritional treatment of diabetes. She mentioned how having her patients stop drinking sugar (soda, juice, sweet teas), had remarkably improved health with just this one change. I agreed, chiming in that the massive amounts of fructose and sugar must me wreaking havoc on their livers, as the liver is the only site where fructose can be processed. The next thing she told me blew my mind:

Many of the children she sees as early as 5 years old are developing non-alcoholic fatty liver disease (NAFLD). Either we have some seriously negligent parents who are letting their kids start swigging vodka right after they get off breast milk, or little kids are eating way too much sugar!


Non-alcoholic fatty liver disease occurs when the liver is overloaded with more sugar than it can process. When this happens, the process of de novo lipogenesis starts - the conversion of carbohydrates in to "new fat", also known as triglycerides. As you may be aware, elevated triglycerides are not a good sign, and when this chronically happens at the liver, it can lead to hepatic cirrhosis (scarring of the liver).

The liver is a pretty important organ, if you know someone who's consuming tons of sugar, let them know that they are damaging it! The fact that we are seeing this in children as young as five is outrageous, as this condition is usually only seen in
diabetics or chronic alcoholics.

Recent studies

Research in the last 2 years (2,3) is showing that NAFLD is associated with increased mortality. A February 2010 Science Daily article reported on the new study that,
"findings suggest that for this study population, persistently elevated serum levels of liver enzymes was associated with an increased risk of death during the 28-year study period. Patients with NAFLD and NASH had a much higher risk of death than the general population but not as high a risk as for patients with chronic viral hepatitis or alcoholic liver disease."(1)
Apparently these findings are confirming what we already suspected: messing up your liver messes up your life. Decreased survival is not a good outcome...


Cut the soda, fruit juice, candy, and sugar out of your diet to live longer.

Update 11/23 : Preventing Fatty Liver


1. Wiley-Blackwell (2010, February 1). Non-alcoholic fatty liver disease associated with high mortality rates. ScienceDaily. Retrieved October 2, 2010, from

2. Paul Angulo. Long-term mortality in NAFLD. Is liver histology of any prognostic significance? Hepatology, 2010; NA DOI: 10.1002/hep.23521

3. Cecilia Söderberg, Per Stål, Johan Askling, Hans Glaumann, Greger Lindberg, Joel Marmur, and Rolf Hultcrantz. Decreased survival of subjects with elevated liver function tests during a 28-year follow-up.Hepatology, 2009; n/a DOI: 10.1002/hep.23314


  1. Wow! this is a very serious issue! Quite honestly I don't think very many people know about NAFLD. Before reading your post I had no idea of the severe effects of sugar on the liver. I was wondering, just for comparison, what the range would be for elevated triglycerides for a child who has NAFLD, a child who is at risk for NAFLD, and the range for a healthy child? Also, other than decreasing the amount of sugar consumed, is diet the main way to control this or would exercise play an essential role as well?

  2. Good question on the triglyceride ranges- I'm not sure how much data has been collected on the triglyceride numbers but I'll look in to it, I'm sure they are practically off the charts.

    As far as controlling NAFLD, it looks like diet is about 95% of this issue. You could potentially try to out-exercise the fructose intake to prevent weight gain, but the liver still has to process all the fructose that enters the body and it would be really difficult for a child.

  3. Don't forget that those who have NAFLD are not "normal" in that their disease causes a variety of metabolic alterations. In other words, sugar in people without disease does not have the effects it would have in people with NAFLD.

  4. People with NAFLD are certainly going to have altered metabolisms which further the damaging effects of sugars. But research suggests that excessive sugar (particularly fructose) intake is a causative factor in developing NAFLD, not only a problem for people that have it.

    Nonalcoholic Fatty Liver Disease in Humans Is Associated with Increased Plasma Endotoxin and Plasminogen Activator Inhibitor 1 Concentrations and with Fructose Intake
    J. Nutr., Aug 2008; 138: 1452 - 1455.

    Effect of Fructose Overfeeding and Fish Oil Administration on Hepatic De Novo Lipogenesis and Insulin Sensitivity in Healthy Men
    Diabetes, Jul 2005; 54: 1907 - 1913.

    Amelioration of high fructose-induced metabolic derangements by activation of PPAR
    Am J Physiol Endocrinol Metab, May 2002; 282: E1180 - E1190.

    Hypertension. 2005 May;45(5):1012-8. Epub 2005 Apr 11.
    Fructose-induced fatty liver disease: hepatic effects of blood pressure and plasma triglyceride reduction.

  5. So may I presume that in addition to fructose, the "sugar" culprit you are referring to is sucrose or can the monosaccharide glucose and the disaccharides lactose and maltose also be implicated?

  6. Absolutely. Fructose must be processed by the liver before it can be used, which makes it the most problematic. You are correct in presuming that other sugars contribute to the same problem, they are not quite as bad though.

    Sometimes when people ask me about which sugar is worse, I reply with a question: Is burning yourself with 220 degree water worse than burning yourself with 215 degree water? Yeah, a little bit but you get burned either way. Sugar is the same way.

  7. I was not aware of this disease before reading this. I only thought that excessive amounts of sugar led to diabetes, but this takes it to another level. The studies done on NAFLD are evidence that the importance of starting a healthy diet from a young age is more crucial to health than most people are aware of.