Narayana Health Care

It is very important to take care of our liver right from early childhood. There is an exponential rise in the prevalence of fatty liver in the last 5-6 years in developing countries like ours owing to the exposure of our young children to an “obesogenic” environment. This complex and multidimensional scenario is composed of diverse factors that promote a child’s overall energy imbalance (i.e., towards a sustained positive energy balance) such as increased availability (food supply) and overconsumption of low-nutrient, energy-dense foods; modern sedentary lifestyle, higher screen time, among others, leading a state of excess fat deposition in the body and liver in particular. Studies have shown that 22.4% of children have fatty liver; 18.9% in normal-weight and 45.6% are in the overweight category.

Childhood fatty liver disease is an acquired liver disease, characterized by the accumulation of fat in the liver in the absence of metabolic or genetic causes or infection. Fatty liver in children is fast becoming the most common liver disease in children and one of the most common causes of liver transplant in adults.  Fatty liver in children is more severe than in adults, with up to 15% of cases diagnosed with advanced stage. Progression of liver disease to advanced fibrosis and cirrhosis can occur during childhood. Children with fatty liver disease have 14 times the risk of progression to severe liver disease or death when compared to children without fatty liver disease.

Among the preventable infections of the liver in children, the most important are Hepatitis A and Hepatitis E. Together Hepatitis A and E infections are the major contributors to the overall childhood liver disease burden in developing countries like India. Children usually get hepatitis A and E by eating hygienically cooked food or sewage-contaminated water. This happens especially during monsoon season and hence cases rise drastically from July- to October each year.

Important dietary behaviors and lifestyles to maintain healthy liver:

Lifestyle modifications to improve diet and increase physical activity are recommended from early childhood. Energy restriction is the most effective strategy for avoiding obesity/overweight.

1. The basic principle of all the dietary strategies is a higher intake of legumes, cereals such as whole grains, fruits and vegetables, moderate to high consumption of fish, low consumption of meat and meat products and moderate consumption of dairy products.
2. Intake of red meat, viscera, refined grains, and/or sugars should be avoided
3. Avoid excessive intake of processed foods- bakery items, deep-fried foods, confectionaries, fast foods, juices, energy drinks
4. Avoid sugar-sweetened beverages.
5. Regular physical activity as part of recreation and leisure (play, games, sports or planned exercise), physical education, transportation (wheeling, walking and cycling).
6. Avoid self-administration of complementary and alternate medications.
7. Avoidance of sedentary lifestyle behaviors
8. Screen time including smartphone, tablet use, TV viewing, video game playing, computer use is limited to 2 hours per day.
9. Avoid intake of uncooked (salads, cut fruits) or unhygienically prepared foods, especially during the rainy season.
10. Plenty of fluid intakes to maintain adequate hydration
11. Seeking early medical advice in case of any symptoms of liver disease.

Dr. Mridul Chandra Das, Consultant & Head Department of Pediatric Gastroenterology, Hepatology & Liver, Transplant Physician, Narayana Super Speciality Hospital, Gurugram.