Threat Grows from Liver Illness Tied to Obesity

Anahad O'Connor, New York Times, June 13, 2014

Despite major gains in fighting hepatitis C and other chronic liver conditions, public health officials are now faced with a growing epidemic of liver disease that is tightly linked to the obesity crisis.

In the past two decades, the prevalence of the disease, known as nonalcoholic fatty liver, has more than doubled in teenagers and adolescents, and climbed at a similar rate in adults. Studies based on federal surveys and diagnostic testing have found that it occurs in about 10 percent of children and at least 20 percent of adults in the United States, eclipsing the rate of any other chronic liver condition.

There are no drugs approved to treat the disease, and it is quickly becoming a leading cause of liver transplants around the country.

Doctors say that the disease, which causes the liver to swell with fat, is particularly striking because it is nearly identical to the liver damage that is seen in heavy drinkers. But in this case the damage is done not by alcohol, but by poor diet and excess weight.

“The equivalent of this is foie gras,” said Dr. Joel E. Lavine, the chief of pediatric gastroenterology, hepatology and nutrition at NewYork-Presbyterian Morgan Stanley Children’s Hospital. “You have to force feed ducks to get fatty liver, but people seem to be able to develop it on their own.”

Gavin Owenby, a 13-year-old in Hiawassee, Ga., learned he had the disease two years ago after developing crippling abdominal pain. “It’s like you’re being stabbed in your stomach with a knife,” he said.

An ultrasound revealed that Gavin’s liver was enlarged and filled with fat. “His doctor said it was one of the worst cases she had seen,” said Gavin’s mother, Michele Owenby. “We had no idea anything was going on other than his stomach pain.”

With no drugs to offer him, Gavin’s doctor warned that the only way to reverse his fatty liver was to exercise and change his diet. “They told me to stay away from sugar and eat more fruits and vegetables,” Gavin said. “But it’s hard.”

Most patients have a less severe form of the disease, with no obvious symptoms. But having nonalcoholic fatty liver is a strong risk factor for developing heart disease and Type 2 diabetes. And in 10 to 20 percent of patients, the fat that infiltrates the liver leads to inflammation and scarring that can slowly shut down the organ, setting the stage for cirrhosis, liver cancer and ultimately liver failure. Studies show that 2 to 3 percent of American adults, or at least five million people, have this more progressive form of the disease, known as nonalcoholic steatohepatitis, or NASH.

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Fatty liver strikes people of all races and ethnicities. But it is particularly widespread among Hispanics because they frequently carry a variant of a gene, known as PNPLA3, that drives the liver to aggressively produce and store triglycerides, a type of fat. The variant is at least twice as common in Hispanic Americans compared with African-Americans and non-Hispanic whites.

In Los Angeles, liver disease is diagnosed in one out of two obese Hispanic children, and it is a leading cause of premature death in Hispanic adults.

At the University of California, Los Angeles, home to one of the largest liver transplant centers in the world, nearly 25 percent of all liver transplants are performed because of NASH, up from 3 percent in 2002. If the prevalence of NASH continues to increase at its current rate and effective treatments are not found, about 25 million Americans will have the disease by 2025, and five million will need new livers, said Dr. Ronald W. Busuttil, chief of the division of liver transplantation at the David Geffen School of Medicine at U.C.L.A.

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  • Since Hispanics donate organs at a far lower rate than whites, this will simply place greater pressure on the (fixed) supply on transplantable livers available to us.

    • Whitetrashgang

      Maybe could give them cow livers or something along that line.

  • Fight liver disease in Hispanics, reduce their food stamp benefits.

    Because, not doing so would be some sort of racism. Right?

  • Larry Klein

    I wonder if you’re better off being average weight, and a heavy drinker versus being a light drinker and being obese?

    • Whitetrashgang

      Way better off being of average weight, for example people who don’t eat one day a week have half of the strokes and heart attacks of people who eat every day. Being fat basically destroys your whole body. Thats why you see rock stars who drink and smoke every day but are thin have pretty good health compared to most people.

      • IstvanIN

        You may have something there, some of those old rockers are very shriveled looking yet they continue on. Fat worse than booze? Maybe.

      • Katherine McChesney

        Smoking raises the metabolism. I was a smoker and was very thin, but after years of not smoking I have gained weight. I only eat one meal a day. Usually a meat and a vegetable with fruit.

        People who drink and smoke every day are far from being healthy.

        • Whitetrashgang

          Should of said compared to most fat people.

    • Fatty liver disease in boozehounds can develop at an absolute crawl if they watch their intake of other fats. The fats that are produced in the liver via metabolism of alcohol are metabolized themselves, provided the individual’s body isn’t being overloaded with dietary fats and high fructose corn sweetener, which is nothing like real sugar. Real sugar is absorbed through the stomach lining into the bloodstream, where it is regulated by the pancreas. HFCS is metabolized only in the liver, and so it’ll produce fatty liver disease.

      HFCS really ought to be taken off the market, but the corn lobby has too much pull for the feds to do anything.

      • DaveMed

        I believe that sugar is absorbed through the small intestine.

      • Hallie Eva

        Real sugar is absorbed through the stomach

        No, not correct, MCS. Sugar absorption takes place through the lining of our small bowel.

        • My point still stands in the general sense. As a trained chemist, but not a biologist, I once thought “sugar is sugar is sugar”. That isn’t so. High Fructose Corn Sweetener is metabolized only in the liver, which is why so many consumers of carbonated sodas and “healthy” “fruit juices” loaded with HFCS develop fatty liver disease.

          Bottled iced tea? That’s got HFCS in it. Brew your own and learn to like it unsweetened. Iced tea is refreshing, and it doesn’t need to taste like liquid candy.

          Snapple? This is water loaded with HFCS and just enough genuine fruit content in it to be legally considered “juice”. In spite of the advertising money they paid drug-addict and radio huckster Rush Limburger to plug this product in the 1990s, this is not a “health” drink.

          The list of these wonderful beverages is nearly endless. Look at the label first.

    • DaveMed

      Alcohol inflicts heavy damage on the liver; cirrhosis is no fun.

      Tough to say which is the lesser of two evils.

      • Yes alcohol sure does, but this is a direct result of the fat buildup inside it from earlier alcohol abuse.

  • No wonder Mexicans are so in favor of Obamacare. They need it. Yet with several articles I’ve read here about Hispanics health problems, I sure see a lot of old Mexicans everywhere in south Texas. Somehow, they hang on before dying in their 80s.

  • Adolf Verloc

    Uh-oh. While I’m not Hispanic, I’m beginning to realize that I need to give a little attention to this.

    • ShermanTMcCoy

      Some treatments that might help:

      1) Metformin

      2) The Newcastle Diet

      Google them

  • JackKrak

    What are the odds that this same author who writes that a certain gene is “particularly widespread among Hispanics” also fervently believes that race doesn’t exist?

  • Truth Teller

    Never donate organs because non Whites have priority.

    • Flossie

      Agreed. Yet another drawback of diversity is the paucity of organ donors. Turns out that sort of charity is strictly a white thing, and now whites are opting out unless a family member is involved.