What Treatments Are Shaping the Future of Pediatric Fatty Liver Health?

The public health threats that impact adults have begun affecting children. While science has made considerable advances in combating infectious diseases, modern demands have created additional problems. One is the increase in pediatric fatty liver.

What can you do if you’re a parent or caregiver? How do you treat fatty liver in children? What new medicines offer hope, and what can you do to mitigate symptoms or reverse disease progression? Here’s a closer look at the treatments shaping the future of pediatric fatty liver health.

What is pediatric fatty liver?

You might have heard of non-alcoholic fatty liver disease, which also strikes children. There are two main types of the disorder1:

• Simple fatty liver disease: When the child accumulates fat in the liver with no inflammation or damage.
• Non-alcoholic steatohepatitis: NASH is a severe condition that results in cellular inflammation and damage, and can lead to cirrhosis or cancer.

Note that the severe form of the disorder now goes by a new name — Pediatric metabolic dysfunction-associated steatotic liver disease or MASLD2. This change eliminates stigmatizing terms associating the condition with the word “fatty” or “alcohol.” It’s crucial not to blame the child. MASLD is no more their fault than cancer, and implying so can have a devastating impact on their mental health.

What causes pediatric fatty liver?

Doctors remain unsure of what causes some kids to develop pediatric fatty liver. However, they have identified several risk factors, many metabolically related. For example, the condition is prevalent in children with:

• Obesity
• Type 2 diabetes and prediabetes
• High lipid disorders
• Insulin resistance

Additionally, the disorder is more prevalent in children with hepatitis C. Finally, sudden, rapid weight loss may predispose a child to the condition.

Is there a cure for pediatric fatty liver?

There is no definitive cure for this disorder. However, doctors have discovered you can treat pediatric fatty liver by implementing lifestyle changes. These shifts can stop or even reverse the damage to a young liver, as this organ has impressive regenerative powers3.

That’s good news for families who struggle with high health care costs. While you may not be able to afford more innovative treatments, you can still improve your kid’s health.

New Medications in the Battle Against Pediatric Fatty Liver

Several medications are in the clinical trial stage, so they aren’t available to the public yet. However, parents and caregivers can talk to their doctors about participating in such research, search for trials on ResearchMatch or join the National Institutes of Health All of Us research program4, 5.

One medication in the trial stages is Gemcabene. Preliminary studies have found it effectively inhibits inflammation and reduces lipid levels6.

Another medication receiving attention is metformin. Preliminary research indicates it may improve insulin sensitivity and lipid profiles in kids with obesity and MASLD7. The FDA has approved this medication for use in children 10 or older with Type 2 diabetes, so your doctor may prescribe it.

Other medications in stage three include8:

• Obeticholic acid
• Lanifibranor
• Resmitirom
• Semaglutide

You might recognize semaglutide, as it made recent headlines as a weight-loss medication in adults. It’s not for use in children, although the FDA recently approved its use in kids 12 and older if their weight falls into the 95th percentile for their age9. Talk to your doctor if you think your child might benefit.

However, it’s crucial to note you can improve pediatric liver health and reverse damage through lifestyle changes alone. Challenges occur when modern realities make these interventions harder. While society-wide change takes time, there are steps any family can take — regardless of income level — to help little one child heal.

How Do You Improve Pediatric Fatty Liver Health in Children?

How can parents and caregivers best treat pediatric fatty liver with the tools available? How do you improve pediatric fatty liver health? Here are your best options.

Partner with your doctor. Be upfront about the challenges you face. Although traditional Western medicine only treats symptoms, many physicians today take a more holistic approach, recognizing various factors impact health.

For example, where you live, how you work, and even typically the ways you eat and sleep can impact your child’s health. If there are barriers to their suggestions, speak up — two heads are better than one, and they can help you brainstorm solutions.

1. Medical Interventions

As of today, there are no approved medications specifically for pediatric fatty liver health. In some cases, your child may qualify for metformin or semaglutide.

In rare cases, they may qualify for bariatric surgery if they have a BMI of 35 or greater, and a related health condition like MASLD10. Preparing for this surgery is difficult, but it is an option.

1. Lifestyle Interventions

The good news is you can improve pediatric fatty liver health through lifestyle interventions alone. The challenge comes with fitting them into your routine.

Exercise

Children need movement for many reasons. Preventing and reversing MASLD is one, but they also benefit in other ways, including11:

• Stronger bones
• Improved balance and coordination
• Increased motor skills
• Greater flexibility

Problems arise when parents work long hours, relying on screens as babysitters. Kids don’t know how to exercise and need supervision at the playground — if a safe one is nearby. Here’s where knowing your neighbors comes in handy. Even in rough areas, committed groups of parents can connect, offer safe places where children can go if they feel threatened, and keep a watchful eye on one another. Reach out to other caregivers.

If you have time, get out there. Young ones naturally love to run, skip, and jump — presenting the opportunity results in active play. Take weekend hikes, make the playground a daily stop, and even incorporate it into your fitness routine. You can do bench squats and triceps dips while your kids zip down the slide.

However, reality sometimes says that failing to work long hours means losing housing — a far more immediate health threat. What can such parents do to encourage movement in their children? Here are some suggestions that may help:

• Use apps: Technology can increase obesity in children, but it can also be your partner in health. Streaming apps Workouts for Kids at Home, Kids Morning Exercise, Yoga for Kids and Family Fitness, and GoNoodle make movement accessible and fun. YouTube is another resource where you can find fitness videos for free.
• Use fitness as transportation: Most adults don’t get enough movement, either. Look for sneaky ways to combine it with your errands. For example, can you wake up a few minutes earlier to walk them to school instead of driving? Can you bike to the store together to pick up milk for dinner?
• Work out with your child: Kids can do many of the same activities as adults. If you use a fitness app like DailyBurn, invite your child to participate. Make it a game — who can do the moves best?
• Dance: Upbeat music encourages folks of all ages to boogie down. Make it a staple in your household and bust a few moves to enthuse your little one. Challenge them to a dance-off — it will make you both laugh and ease stress.
• Everyone does their share: Chore time is a chance to move. Crank those tunes while scrubbing your pad with your child. You’ll feel better in a tidier abode as a bonus.
• Schedule social activities: You might have limited time for playdates. Ensure they’re active when you do.
• Keep it fun: Seek more time for play, even if it's only five or 10 minutes of catch on a WFH break.

1. Dietary Changes

Dietary changes combine with increased movement to manage pediatric fatty liver health. Here, too, modern lifestyles can complicate issues, but knowing a few basics can make it easier for parents to make better choices for their children.

First, you must learn to read labels and know what to avoid:

• Added sugar: Including glucose, fructose, sucrose, table sugar, high-fructose corn syrup, corn syrup, brown rice syrup, dextrin, dextrose, maltodextrin, and crystalline glucose.
• Bleached flour: Many people see the words “wheat” or “wheat flour” on ingredient labels and bags of all-purpose flour and think “healthy.” However, the manufacturing process strips away the bran and chaff, leaving behind a gluey substance that your body absorbs as quickly as sugar. Look for the words “whole grain” or “whole wheat” to indicate the good stuff remains to stabilize your child’s blood sugar.

Perhaps the number one dietary change you can make is eliminating soda and juice from your child’s diet. They’re nearly all fructose or high-fructose corn syrup. While all added sugar is problematic, fructose may be the worst because your liver almost exclusively metabolizes it12.

Knowing how to read labels and avoid these ingredients is tough, as many of the convenience foods your kids crave come loaded with the stuff. However, more healthy options arise as manufacturers strive to fulfill needs.

The best change you can make is shifting to whole foods that look like they do in nature. Meal prepping takes a learning curve, but it can be much less expensive than convenience meals while increasing your nutritional intake considerably. The internet abounds with easy freezer meals you can make on your day off and pop in the slow cooker on busy days.

While some farmer’s markets have evolved into pricier crafts fairs and flea markets, they’re still cheaper than grocery stores on average for fresh, organic produce. Additionally, gardening — even in indoor containers — increases movement and provides fresh food for your family. Learn how to save seeds and start a few crops to teach your kids about science while nurturing their bodies13.

1. Nutritional Supplements

Research continues into nutritional supplements that may help with MASLD. However, the following nutrients and herbs have shown effectiveness in trials and may benefit your child14:

• Vitamin E
• Vitamin D
• Omega-3 fatty acids
• Garlic powder
• Black cumin seed
• Sumac powder
• Olive oil

Consult your physician before starting a supplement regimen. While many are safe if taken as recommended, they can interfere with other medications you take and are largely unregulated.  John Travis — senior researcher at NSF International suggests — “Also, look for an independent certification mark on the label,” which helps ensure the product contains what it claims.

1. Supportive Care

One more wrinkle in the battle for pediatric fatty liver health is the psychosocial and emotional components. Pressures like poverty, family discord, and bullying can cause stress that complicates children’s health outcomes. For example, they may turn to emotional overeating to cope15. Besides encouraging weight gain, diets high in sugar can lead to addiction-like behaviors as they affect the same brain regions as cocaine16.

Therefore, parents, caregivers, and health care providers must address the mental and emotional components of MASLD. Parents can teach healthy interventions — like yoga, deep breathing, engaging in a hobby or blowing off steam through exercise — for coping with challenging feelings. Physicians can encourage these behaviors and refer patients to counseling to address the underlying issues prompting children to overeat.

Early intervention is key, so begin making changes at the first signs of obesity. According to Sandra Hassink, MD — vice president of the Clinical Practice Guideline Subcommittee on Obesity — “The goal is to make changes in lifestyle, behaviors or environment that are sustainable.” Take swift action, but eliminate one thing at a time, perhaps starting with soda, to gradually implement lasting changes.

Treating Pediatric Fatty Liver

The good news is you can improve pediatric liver health without medication or surgery. While these changes are challenging, knowing the causes of MASLD and how to treat it leads to improved outcomes and happier kids. Please seek medical evaluation if you think your child has an issue with pediatric fatty liver, and implement these lifestyle changes to prevent and treat the condition.

References:

1. “What is fatty liver disease?” (n.d.) https://www.childrenshospital.org/conditions/fatty-liver
2. Pediatric metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD) - Mayo Clinic. (2023, October 4). https://www.mayoclinic.org/medical-professionals/pediatrics/news/pediatric-metabolic-dysfunction-associated-steatotic-liver-disease-masld-formerly-known-as-nonalcoholic-fatty-liver-disease-nafld/mac-20555493
3. HealthMatch staff & HealthMatch Pty Ltd. (2023, March 1). Liver regeneration: Steps to grow back your liver. HealthMatch. https://healthmatch.io/liver-disease/liver-regeneration
4. ResearchMatch. (n.d.). https://www.researchmatch.org/
5. All of US Research Program | National Institutes of Health (NIH). (n.d.). All of Us Research Program | NIH. https://allofus.nih.gov/
6. Besekar, Smruti M., Jogdan, Sangita D. and Nagyi, Wagar M. “A systematic review of the randomized controlled trials of Gemcabene and its therapeutic uses.” National Institutes of Health (NIH). (2023, March, 28). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10136367/
7. Cheriekis, Konstantinos, et. al. “The benefit of metformin in the treatment of pediatric non-alcoholic fatty liver disease: a systematic review and meta-analysis of randomized controlled trials.” National Institutes of Health (NIH). (2023, Aug, 28). https://pubmed.ncbi.nlm.nih.gov/37639015/
8. Yin, X., Guo, X., Liu, Z., & Wang, J. (2023, February 2). Advances in the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease. International Journal of Molecular Sciences. https://doi.org/10.3390/ijms24032844
9. Williams, L. (2023, January 9). FDA approves high-dose semaglutide for adolescents with obesity. Diabetes.medicinematters.com. https://diabetes.medicinematters.com/semaglutide/obesity/us-fda-children-obesity/23902216.
10. Pediatric and Adolescent Bariatric Surgery | Children’s National. (n.d.). Children’s National Hospital. https://www.childrensnational.org/get-care/departments/bariatric-surgery-program
11. Kaplan, M. (2023, March 16). Benefits of physical play for Children | PlayWorld. Playworld® Blog. https://playworld.com/blog/benefits-of-physical-play/#gref
12. Hendriks, A. D., Veltien, A., Voogt, I. J., Heerschap, A., Scheenen, T. W. J., & Prompers, J. J. (2023). Glucose versus fructose metabolism in the liver measured with deuterium metabolic imaging. Frontiers in Physiology, 14. https://doi.org/10.3389/fphys.2023.1198578
13. Link, K. (2023, August 18). Why heirloom seeds matter - FoodPrint. FoodPrint. https://foodprint.org/blog/heirloom-seeds/.
14. Wang, L., Zhang, P., & H, Y. (2023). Functional foods and dietary supplements in the management of non-alcoholic fatty liver disease: A systematic review and meta-analysis. Frontiers in Nutrition, 10. https://doi.org/10.3389/fnut.2023.1014010
15. “Emotional Eating” KidsHealth.org (n.d.) https://kidshealth.org/en/teens/emotional-eating.html.
16. Is Sugar More Addictive Than Cocaine | Ramsay Healthcare. (n.d.). https://www.ramsayhealth.co.uk/blog/lifestyle/is-sugar-more-addictive-than-cocaine