EL CAJON, Calif. — When doctors told Carmen Hurtado that her 8-year-old was sick with a condition known as fatty liver disease, her first reaction was not fear. It was confusion.
Liver transplants have likewise grown among adolescents and young adults, with a 25 percent increase during the past decade in children 11 to 17 years old, data from the United Network for Organ Sharing shows. Transplants for young adults 18 to 34 more than doubled in the past. Dani gets a checkup with gastroenterologist Kimberly Newton at the UC-San Diego Altman Clinical and Translational Research Institute. are highest. But obesity is only part of the puzzle. Scientists have been surprised to find that not all kids with obesity have fatty liver, and not all kids who have fatty liver disease struggle with weight.
The wave of pediatric fatty liver disease has come on so fast that the medical community is scrambling to understand its epidemiology, risk factors, screening, diagnosis and management. Doctors have expressed alarm that no Food and Drug Administration-approved treatments exist and that some of the most promising interventions — such as a new generation of weight-loss medications — are impossibly expensive and usually not covered by health insurance for fatty liver.
Hannibal Person, an assistant professor of pediatrics at the University of Washington and a pediatric gastroenterologist at Seattle Children’s Hospital, said fatty liver disease speaks to the— including subsidies given mostly to White farmers, and grocery store “deserts” mostly in predominantly poor, minority areas: “A lot of it has to do with where you live and access to fresh food, how advertisers are targeting you, and the cultural realities of what you eat.
Jeffrey Schwimmer was a young doctor a few months into his job at Rady Children’s Hospital in San Diego when in 2000 he began to see an unusual pattern of children with enlarged, discolored and scarred livers. “The kind you’d see in an adult with chronic alcohol abuse,” he remembers thinking. Schwimmer, a pediatric gastroenterologist who also does research at the University of California at San Diego,
The anti-fat craze marked the ascendancy of artificial substitutes, created in industrial labs and partially digested before people eat them. Their use altered how food is dealt with in the large intestine, a few studies suggested, potentially failing to trigger bacteria that live there and are essential to health, and thus changing in potentially negative ways our microbiomes — the community of microorganisms that exist in the gut and play a role in mood, cognition and disease.
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