|
AP IMPACT: Liver disease plagues obese adolescents
2008-09-07
TRENTON, N.J. - In a new and disturbing twist on the obesity epidemic, some overweight teenagers have severe liver damage caused by too much body fat, and a handful have needed liver transplants. Muzi.com News 10078285-0 (muzi.com)Many more may need a new liver by their 30s or 40s, say experts warning that pediatricians need to be more vigilant. The condition, which can lead to cirrhosis and liver failure or liver cancer, is being seen in kids in the United States, Europe, Australia and even some developing countries, according to a surge of recent medical studies and doctors interviewed by The Associated Press. Muzi.com News 10078285-1 (muzi.com) The American Liver Foundation and other experts estimate 2 percent to 5 percent of American children over age 5, nearly all of them obese or overweight, have the condition, called nonalcoholic fatty liver disease. Muzi.com News 10078285-2 (muzi.com) "It's clearly the most common cause of liver disease," said Dr. Ronald Sokol, head of public policy at the liver foundation and a liver specialist at Children's Hospital and University of Colorado Denver. Muzi.com News 10078285-3 (muzi.com) Some experts think as many as 10 percent of all children and half of those who are obese may suffer from it, but note that few are given the simple blood test that can signal its presence. A biopsy is the only sure way to diagnose this disease. Muzi.com News 10078285-4 (muzi.com) As fat builds up, the liver can become inflamed and then scarred over time, leading to cirrhosis, a serious condition, which in years past was mostly caused by hepatitis or drinking too much alcohol. Liver failure or liver cancer can follow, but if cirrhosis has not yet developed, fatty liver disease can be reversed through weight loss. Muzi.com News 10078285-5 (muzi.com) The disease is most common in overweight children with belly fat and certain warning signs, such as diabetes or cholesterol or heart problems. However, it's been seen in a few children of normal weight. Muzi.com News 10078285-6 (muzi.com) Genetics, diet and exercise level all play a role. It is most prevalent among Hispanics, relatively rare among African-Americans, and more common among boys than girls. Muzi.com News 10078285-7 (muzi.com) "There are people in their 30s or early 40s that will require a liver transplant" from developing the condition as a kid, predicts Dr. Jose Derdoy, head of liver transplants at Cardinal Glennon Children's Medical Center in St. Louis. He's treated a 15-year-old, 530-pound boy and many others with the condition. Muzi.com News 10078285-8 (muzi.com) Experts blame obesity, with about two-thirds of all Americans overweight. With fatty liver disease becoming more common in adults, many experts predict it will become the top cause of liver transplants by 2020. Muzi.com News 10078285-9 (muzi.com) "There aren't enough livers to go around," says Dr. Philip Rosenthal of the University of California-San Francisco Children's Hospital. Muzi.com News 10078285-10 (muzi.com) His patient, Irving Shaffino, a 15-year-old Mexican-American who lives outside Lubbock, Texas, was lucky to get a transplant a year ago. He was in end-stage cirrhosis and, at 5-feet-4 1/2, weighed 180 pounds. Muzi.com News 10078285-11 (muzi.com) Irving had been fat since age 6, thanks to a high-starch, high-fat diet of Mexican food, pizza and burgers, said his mother, Guadelupe Shaffino. At age 8, she said, he had a distended stomach and by his early teens, breathing problems kept him tethered to an oxygen tank at home. Muzi.com News 10078285-12 (muzi.com) Without health insurance, the family couldn't find a local hospital that would do a transplant. Muzi.com News 10078285-13 (muzi.com) "My son begged me, 'Don't let me die, Mommy,' so I did everything in my power to find a place to help him. Thanks be to God, we found a way," said Guadelupe Shaffino, a restaurant cook. Muzi.com News 10078285-14 (muzi.com) UCSF Children's Hospital, with money from a state health program, agreed to do the transplant. Rosenthal, who oversees the hospital's pediatric liver transplant program, took over care of Irving. The doctor said without a new liver Irving would have died, maybe within months. Muzi.com News 10078285-15 (muzi.com) "He was in bad shape," said Rosenthal. Muzi.com News 10078285-16 (muzi.com) Soon after tests were completed and Irving got on a transplant waiting list, an organ was found. Muzi.com News 10078285-17 (muzi.com) "It felt like a miracle, because people say you could be on the transplant list for years," Irving said. Muzi.com News 10078285-18 (muzi.com) Within a couple of months of the July 26, 2007 operation, Irving had weaned himself from the oxygen tank and could go on walks, although he got winded quickly. Muzi.com News 10078285-19 (muzi.com) Back home in Texas, his medications are down from 11 to four and Irving said he's replaced soda and fast food with fruit, vegetables and whole grains. Muzi.com News 10078285-20 (muzi.com) "I want to get into sports again," he said. "I want to get down to maybe 150" pounds. Muzi.com News 10078285-21 (muzi.com) Sadly, however, Irving has made little progress in losing weight. While he's grown an inch and a half since his operation, he's still obese and his weight was up to 219 last month. Muzi.com News 10078285-22 (muzi.com) Specialists say many kids diagnosed with fatty liver disease come to subsequent checkups heavier, and at best, just one in four loses significant weight, the only treatment known to stop and even reverse the disease. Muzi.com News 10078285-23 (muzi.com) "My patients that are successful, the whole family has bought in," increasing exercise and changing diet, said Dr. Stephanie Abrams, a liver and obesity specialist at Texas Children's Hospital. "The problem is that we aren't changing society in favor of becoming lean." Muzi.com News 10078285-24 (muzi.com) The scope of the disease has only been realized in recent years. Just a handful of cases were reported in medical journals in the 1980s, and in the past, many adult patients were thought to be lying when they denied drinking alcohol. Muzi.com News 10078285-25 (muzi.com) Only three liver transplants on American children with nonalcoholic fatty liver disease were recorded from 1990 through 2002; two were done last year. Muzi.com News 10078285-26 (muzi.com) "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." Muzi.com News 10078285-27 (muzi.com) 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. Muzi.com News 10078285-28 (muzi.com) "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." Muzi.com News 10078285-29 (muzi.com) 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. Muzi.com News 10078285-30 (muzi.com) "Many of these children, their parents have it (fatty liver disease) and don't know it," said Schwimmer. Muzi.com News 10078285-31 (muzi.com) 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. Muzi.com News 10078285-32 (muzi.com) 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. Muzi.com News 10078285-33 (muzi.com) Within the last several months, there's been an explosion of research published on it and the role genes may play. Muzi.com News 10078285-34 (muzi.com) 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. Muzi.com News 10078285-35 (muzi.com) Scientists now are seeking the best ways to treat it. Muzi.com News 10078285-36 (muzi.com) 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. Muzi.com News 10078285-37 (muzi.com) 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. Muzi.com News 10078285-38 (muzi.com) 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. Muzi.com News 10078285-39 (muzi.com)
|  | | | Profile |
News154 | Gallery | Links | |
| |
|
|
| 
