For the past few decades there has been a chronic disease plaguing society’s young children. This chronic disease has spread worldwide with the numbers of diseased children is expected to increase in the next decade. This chronic disease is obesity. Along with the rise of obesity among youth, there is a new silent killer linked to childhood obesity. This new chronic disease, typically found in alcoholics, is now becoming prevalent in obese children and is called non-alcoholic fatty liver disease (NAFLD). NAFLD is defined as a liver disease in people who have not consumed alcohol in significant amounts to cause liver damage, and in whom no other etiology for fatty liver is present (Prashant, 2007, p. 401). Ulrich, an MD at the Birmingham children’s hospital, stated, “The term NAFLD covers a spectrum of non-alcoholic fatty liver disease from benign static disease to more aggressive forms that can progress to cirrhosis within childhood” (Ulrich, 2006, p.264). The first report of NAFLD was reported in young obese children during the early 1980’s, and has been seen in children as young as nine years old. Since then, there has not been enough attention paid to NAFLD, and there is a lot to be understood about this chronic disease. To understand NAFLD, researchers and doctors need to investigate on the prevalence, pathogenesis, and detection of NAFLD in obese children.
Since the first report of NAFLD came out in the 1980’s, there has been an increase in childhood obesity which has resulted in the increase of NAFLD in children. The prevalence of NAFLD in obese children has been reported to range from 20 to 77% (Prashant, 2007, p.402). NALFD has been reported in all genders, age groups and ethnicities worldwide. The ethnicities that are at higher risk for developing NAFLD are the Hispanic and Asian populations. Also, studies indicate that males are more at risk of getting NALFD then females. Findings by Sagi, an MD in children pediatrics, showed the increase in liver problems linked to obese children, and “in a prospective study of 84 children (mostly overweight and obese), 58% were found to have increased liver fibrosis” (Sagi, 2007, p.1209). Family histories of obese children’s also play a big factor in the chances of children developing NAFLD. A study of 49 parents showed a clear link in children’s obesity and parents. Sagi (2007) found, “Family obesity was reported in 33 mothers (33/49, 67.3%) and 38 fathers (38/49, 82.6%) of the patients” (p.1210). In the USA, the number of obese children is alarming. Kerekar, an MD at The Mount Sinai Medical Center found that, “In The National Health and Nutrition Examination Survey (NHANES) conducted in the USA revealed that over 20% of children aged 12-17 years old were found to be overweight ( > 85th percentile of BMI for age) and 8 – 17% were obese ( > 95th percentile of BMI for age) in different ethnic groups” ( Kerkar, 2004, p.614). Not only is obesity high in the US, there are alarming results in other countries. Roberts revealed in the Journal of Hepatology that, “In Europe where the prevalence of childhood obesity has doubled or tripled in < 20 years, in Canada, and Australia” (Roberts, 2007, p.1134). The findings from Kerkar and Roberts show that the majority of overweight and obese children are at high risk of developing NALFD regardless of nationality or origin.
The pathogenesis of NAFLD is not totally understood. Prashant an MD in pediatrics stated that, “The pathological spectrum ranges from simple hepatic steatosis, to infiltration by inflammatory cells and mild to moderate fibrosis leading to cirrhosis” (Prashant, 2007, p.401). Therefore, researchers have developed a hypothesis that is widely accepted among pediatric doctors. It is called the two hit hypothesis, and was proposed in 1998. Marion, an MD in children pediatrics, defines the two hit hypothesis, “accumulation of fat “first hit” within the liver, would predisposes it to the “second hit” which then leads...
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