New twist in teen obesity: Some need liver transplants New battle for obese teens: liver disease

Pediatricians are warned to be vigilant about link

Fifteen-year-old Irving Shaffino, with his mother, Guadalupe, in Shallowater, Texas, had a liver transplant in 2007. Fifteen-year-old Irving Shaffino, with his mother, Guadalupe, in Shallowater, Texas, had a liver transplant in 2007. Photo: ZACH LONG, ASSOCIATED PRESS Photo: ZACH LONG, ASSOCIATED PRESS Image 1 of / 1 Caption Close New twist in teen obesity: Some need liver transplants 1 / 1 Back to Gallery

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.

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 U.S., Europe, Australia and even some developing countries, according to a surge of recent medical studies and doctors interviewed.

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.

"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.

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.

Fat linked to cirrhosis

As fat builds up, the liver can become inflamed and then scarred over time, leading to cirrhosis. Liver failure or liver cancer can follow, but if cirrhosis has not yet developed, fatty liver disease can be reversed through weight loss.

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.

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.

"There are people in their 30s or early 40s that will require a liver transplant" from developing the condition as a child, predicts Dr. José Derdoy, head of liver transplants at Cardinal Glennon Children's Medical Center in St. Louis.

"There aren't enough livers to go around," says Dr. Philip Rosenthal of the University of California-San Francisco Children's Hospital.

Transplant recipient

Dr. Rosenthal's patient, Irving Shaffino, a Mexican-American who lives outside Lubbock, 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.

Irving, 15, had been fat since age 6 because of a high-starch, high-fat diet, said his mother, Guadalupe 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.

Without health insurance, the family couldn't find a local hospital that would do a transplant.

UCSF Children's Hospital, with money from a state health program, agreed to do the transplant. Rosenthal said without a new liver Irving would have died, maybe within months.

Soon after tests were completed and Irving got on a transplant waiting list, an organ was found.

"It felt like a miracle, because people say you could be on the transplant list for years," Irving said.

Scant progress in losing

Sadly, however, Irving has made little progress in losing weight since the July 26, 2007, operation. 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.

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 reverse the disease.

"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."

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.

Only three liver transplants on American children with nonalcoholic fatty liver disease were recorded from 1990 through 2002; two were done last year.

Experts say the best way to fight the problem is to intervene early, while it can be reversed.