MUMBAI: There is another reason to keep sugar out of reach: It’s being linked to “fatty” liver among children and adults.
Sugar, often called a white poison, was the cause of a public outcry recently as a global study showed that infant formula and chocolates sold in India had high levels of “added sugars” compared with other countries. Now, at a meeting of paediatricians and hepatologists held in the city, the focus was on how high intake of sugar is linked to fatty liver in children as young as nine.
“Sugar is a big culprit as it’s converted into fat in the liver,” said liver specialist Dr Aabha Nagral of Children’s Liver Foundation. In an overweight or obese child, or even an adult, this fat in the liver fails to get metabolised due to other pre-existing conditions such as insulin resistance.
Fatty liver was traditionally associated with alcoholics, but, in the eighties, doctors noticed “liver beaded with extra fat” even in the absence of alcoholism. This led to the birth of the term non-alcoholic fatty liver disease, or NAFLD, which, in June 2023, was renamed metabolic dysfunction-associated steatotic liver disease or MASLD.
Common in overweight children
Like with alcoholic liver, the non-alcoholic fatty liver, too, leads to scarring, fibrosis, cirrhosis or cancer over decades. In an XXL generation, the age of onset of fatty liver has dipped a lot and the incidence is rising. In a study done in BMC-run Nair Hospital near Mumbai Central railway station, 62% of the children who were found to be overweight or obese had fatty liver. The study, published in the ‘Annals of Hepatology’, an indexed medical journal, had looked at 616 schoolchildren in the 11 to 15 age group; 198 of them were found to be overweight or obese.
“There has been a rise in paediatric obesity since Covid due to the lack of exercises, sedentarism and easy access to junk food,” said Indian Academy of Paediatrics president Dr Nehal Shah. In children with a body mass index of over 25, she said, fatty liver is highly likely. “We need to become vigilant about fatty liver among our children,” she added.
No sugar till 2
“As a population, we take too much sugar. In fact, IAP guidelines say that children should not be introduced to salt till the age of one and sugar till the age of two years,” said Dr Nagral, who organised Hepaticon 2024 focusing on ‘fatty liver disease in children and adolescents: nipping it in the bud’. Discussions also included the role of sugar tax, ban on processed food from school canteens, mandatory exercising at schools, among others.
“As a parent, no one considers fatty liver. It is only picked up when the child goes to the doctor with another complaint such as pain in the abdomen, constipation, etc. Parents don’t take it seriously as it causes no symptoms in the early stages,” said a doctor.
Begins in the womb
Long-term research being done by Dr Chittaranjan Yajnik, a Pune-based diabetologist, examines the risk of fatty liver and some other chronic diseases increasing due to poor nutrition in-utero or in the womb.
D Yajnik’s ongoing study of 30 years looked at low birth babies and their mothers. “We followed the mothers from the time of their pregnancy, noting her various health parameters. We also looked at their children at ages 5, 10, 15 , 20, 30 years,” he said. The study found that the lowbirth baby who had slow growth of liver had a higher risk of fatty liver. “It is possibly intra-uterine deprivation or exposure to poor nutrition that leads to slow growth of the liver,” he said. If such a child later on in life gets exposed to rapid development bordering on overnutrition, the organ cannot handle it well and leads to fatty liver.
Activity helps
Doctors say that cutting down on sugar is a way to reduce fatty liver in the early stages of the condition. Consider 58-year-old Chembur resident Mahavir Sharma who would get a “fatty liver” observation in his regular ultrasound scans. “I took up running five years back and have reduced my weight to 80 kg. In the last ultrasound scan, the doctor said I no longer have a fatty liver,” he said.
Sugar, often called a white poison, was the cause of a public outcry recently as a global study showed that infant formula and chocolates sold in India had high levels of “added sugars” compared with other countries. Now, at a meeting of paediatricians and hepatologists held in the city, the focus was on how high intake of sugar is linked to fatty liver in children as young as nine.
“Sugar is a big culprit as it’s converted into fat in the liver,” said liver specialist Dr Aabha Nagral of Children’s Liver Foundation. In an overweight or obese child, or even an adult, this fat in the liver fails to get metabolised due to other pre-existing conditions such as insulin resistance.
Fatty liver was traditionally associated with alcoholics, but, in the eighties, doctors noticed “liver beaded with extra fat” even in the absence of alcoholism. This led to the birth of the term non-alcoholic fatty liver disease, or NAFLD, which, in June 2023, was renamed metabolic dysfunction-associated steatotic liver disease or MASLD.
Common in overweight children
Like with alcoholic liver, the non-alcoholic fatty liver, too, leads to scarring, fibrosis, cirrhosis or cancer over decades. In an XXL generation, the age of onset of fatty liver has dipped a lot and the incidence is rising. In a study done in BMC-run Nair Hospital near Mumbai Central railway station, 62% of the children who were found to be overweight or obese had fatty liver. The study, published in the ‘Annals of Hepatology’, an indexed medical journal, had looked at 616 schoolchildren in the 11 to 15 age group; 198 of them were found to be overweight or obese.
Expand
No sugar till 2
“As a population, we take too much sugar. In fact, IAP guidelines say that children should not be introduced to salt till the age of one and sugar till the age of two years,” said Dr Nagral, who organised Hepaticon 2024 focusing on ‘fatty liver disease in children and adolescents: nipping it in the bud’. Discussions also included the role of sugar tax, ban on processed food from school canteens, mandatory exercising at schools, among others.
“As a parent, no one considers fatty liver. It is only picked up when the child goes to the doctor with another complaint such as pain in the abdomen, constipation, etc. Parents don’t take it seriously as it causes no symptoms in the early stages,” said a doctor.
Begins in the womb
Long-term research being done by Dr Chittaranjan Yajnik, a Pune-based diabetologist, examines the risk of fatty liver and some other chronic diseases increasing due to poor nutrition in-utero or in the womb.
D Yajnik’s ongoing study of 30 years looked at low birth babies and their mothers. “We followed the mothers from the time of their pregnancy, noting her various health parameters. We also looked at their children at ages 5, 10, 15 , 20, 30 years,” he said. The study found that the lowbirth baby who had slow growth of liver had a higher risk of fatty liver. “It is possibly intra-uterine deprivation or exposure to poor nutrition that leads to slow growth of the liver,” he said. If such a child later on in life gets exposed to rapid development bordering on overnutrition, the organ cannot handle it well and leads to fatty liver.
Activity helps
Doctors say that cutting down on sugar is a way to reduce fatty liver in the early stages of the condition. Consider 58-year-old Chembur resident Mahavir Sharma who would get a “fatty liver” observation in his regular ultrasound scans. “I took up running five years back and have reduced my weight to 80 kg. In the last ultrasound scan, the doctor said I no longer have a fatty liver,” he said.
Sarah Carter is a health and wellness expert residing in the UK. With a background in healthcare, she offers evidence-based advice on fitness, nutrition, and mental well-being, promoting healthier living for readers.
