I Wish I Were Far From the Madding Crowd

April 3, 2010

Obesity, HFCS, and fatty liver disease in children (as well as increased heart disease risk)

I personally am very interested in this topic because just over three years ago I had gone in to see my doctor because of abdominal pain.  My triglycerides and LDL were high.  He thought it might be my gallbladder so I went in for an ultrasound, which revealed that I had a fatty liver.

Fatty liver disease has not been considered a children’s disease, so it’s disturbing to read that children and adolescents are developing it, especially since there are usually few symptoms until the disease has progressed to a more advanced stage of steatohepatitis (aka hepatosteatosis) and scarring has already occurred.

According to the American Heart Association, more than 6 million children in the United States are affected.

High Fructose Corn Syrup Linked to Liver Scarring (HealthDay, March 19, 2010)

Reports on a study, “Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease,” which found that increased consumption of HFCS led to increased fibrosis (scarring) in patients suffering from NAFLD.

Fatty Liver Disease May Raise Heart Disease Risk in Overweight, Obese Kids (American Heart Association, April 3, 2010)

A fatty liver disease that is not well-known in overweight and obese children may be a precursor of cardiovascular disease, researchers reported in Circulation: Journal of the American Heart Association.

The overweight children with NAFLD had significant cardiovascular risk including higher levels of fasting glucose, insulin, total cholesterol, low-density lipoprotein (LDL, “bad” cholesterol), triglycerides and higher systolic and diastolic blood pressure than the control group.

NAFLD is the most common cause of liver disease in children and is associated with metabolic syndrome, a clustering of risk factors for the development of cardiovascular disease and type 2 diabetes. NAFLD is characterized by the presence of oily droplets of triglycerides in liver cells. More than 6 million children in the United States are affected.

NAFLD in overweight children is strongly associated with metabolic syndrome. The association is independent of both body mass index and insulin sensitivity.

Fatty liver disease often has no outward symptoms, which contributes to it going undetected. Although some children will have symptoms such as abdominal pain or fatigue, the majority remain symptom-free until the disease is in very advanced stages.

American Heart Association Scientific Statement on Metabolic Syndrome in Children and Adolescents (2009)

Since 2003, substantial new information has emerged in children on the clustering of obesity, insulin resistance, inflammation, and other risk factors and their collective role in conveying heightened risk for cardiovascular disease and type 2 diabetes. A constellation of these interrelated cardiovascular risk factors in adults has come to be known as the metabolic syndrome.

The scientific statement covers the following topics:

Selected References

Steinberger J, Daniels SR. Obesity, insulin resistance, diabetes and cardiovascular risk in children: an American Heart Association scientific statement from the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism). Circulation. 2003; 107: 1448–1453.[Free Full Text]

Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC, Spertus JA, Costa F. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement [published corrections appear in Circulation. 2005;112:e297 and 2005;112:e298]. Circulation. 2005; 112: 2735–2752.[Free Full Text]

Non-alcoholic fatty liver disease (NAFLD)

Once considered an illness of adults over 40, more and more children are being diagnosed with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH).  NAFLD can be a precursor to NASH, which can progress to cirrhosis.

According to Children’s Memorial Hospital in 2005 an estimated 1.6 million children were affected with fatty liver disease

But the American Heart Association now says that 6 million children have NAFLD (see above).

Note: The Children’s Memorial Hospital’s NASH program is a member of the NASH clinical research network.  In 2005, the NASH clinical research network launched a trial for treatment of liver disease in children. The NASH CRN website contains links to related information for patients.  Most of the website, however, is technical and requires an account to access.)

When complications such as cirrhosis cannot be controlled with treatment or when the liver becomes so damaged from scarring that it completely stops functioning, a liver transplant is necessary.

Both NASH and NAFLD are becoming more common, possibly because of the greater number of Americans with obesity. In the past 10 years, the rate of obesity has doubled in adults and tripled in children. Obesity also contributes to diabetes and high blood cholesterol, which can further complicate the health of someone with NASH.  (From the NASH page on the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) website.)

From “Fatty Liver Disease is Common in the US

Source: Spare the exercise, spoil the liver

More information about fatty liver can be found on the American Liver Foundation’s Fatty Liver page and in their Fatty Liver Brochure.

In case you’re wondering what I did after my diagnosis…

At the ultrasound the technician had said, “Your gallbladder is fine, but you have a fatty liver.”  The way she said it made it sound like it was more than just a casual observation, so when I got home I did a quick search on the National Library of Medicine’s website, where I found a lot of information about NAFLD.  (I’m not a teetotaler, but I don’t drink much.)

The progression from NAFLD to NASH to cirrhosis to needing a liver transplant or you die got my attention. Even before I got the formal diagnosis from my doctor I changed my diet (I started eating fish, raisins, and nuts, as well as more fruit, nuts, raisins, whole grains, leafy green vegetables, and fiber (even tried quinoa); and fewer sugar-sweetened drinks) and lots more exercise.  I dropped about twenty pounds in four months and, more importantly, my triglyceride level dropped a lot.

I had relapsed a bit since then, but after viewing Dr. Lustig’s presentation on the effects of fructose (and having done some follow up reading on the topic) I have once again cut back on sugar consumption and have started working out more regularly once more.

If you’re been sort of blasé about fructose you might find yourself changing your mind if you look at the slides on the “Detrimental Effects of Fructose” from a presentation he gave at the National Institute of Environmental Health Sciences (NIEHS) (pp. 15-27, with final slides on p. 27 showing the end result) and look at how fructose metabolized by the liver ultimately results in the creation of lipid droplets (these are what create a “fatty liver”), FFA (free fatty acids) (which help trigger insulin resistance), and triglycerides (TG), resulting in higher blood pressure and inflammation (among other things).


  1. Thanks for the comment on my blog.

    I work in public education and that is what is in the chocolate and strawberry milk: high fructose corn syrup. We are making kids sicker and sicker with this stuff.

    And if you ever go to the dollar store, that is what is in the cheap processed food there. That is why so many people in poverty are overweight.

    Comment by Michelle Burton — April 4, 2010 @ 9:05 am

    • I visited my Mother in the hospital and was shocked at the ingredients in her heart healthy meals. Chocolate milk with high fructose corn syrup. It was in quite a few of the menu items. You’d think a hospital would know better.

      Comment by mlaiuppa — April 6, 2010 @ 10:12 pm

  2. I discovered that one day picking up my kids one day after school. One of them handed me an empty box of chocolate milk. I looked at the label and was astonished to discover that this small box of milk contained 39 g of sugar!

    I was also stunned when looking through my cupboard that Ovaltine’s first ingredient is sugar! I had been buying it because it was supposed to be so much better for kids than other chocolate mixes (and it still might be). Out of a serving size of 21 g (that’s 4 tbsps) 18 g are sugar. (Yes, in both cases some of the sugars will be lactose, but most will be sucrose.)

    Comment by Myles Tougeau — April 4, 2010 @ 10:04 am

  3. Start reading a lot of packages. HFCS is in a lot of stuff. Yogurt, ice cream, bologna, bread and a lot of pre-processed foods.

    The easiest way to avoid it is to stop drinking soda and stop eating pre-processed foods. Start cooking from scratch. Everyone can make simple meals. As you gain practice, you’ll find yourself getting adventurous.

    Be sure to check out the ingredients you use. No use cooking from scratch if your ingredients contain HFCS. Those may be ketchup, Worstershire sauce or Tabasco sauce. Yes. HFCS is in all three of those unless you buy something that’s either organic or imported.

    Buy a bread machine and a crock pot. A bread machine is really easy to use and you can pick your ingredients, like quinoa flour or whole wheat, stone ground and your can even add whole oats, wheat germ, etc. Rye bread is delicious.

    The crock pot will make it easy to cook beans and make soups with lentils and barley.

    And don’t forget raw. I always like to have some fruit with cooked vegetables or raw vegetables if I’m having whole grains (bread) and something cooked like soup. Lamb is high in Omega3s and sheep are pastured and grass fed.

    Comment by mlaiuppa — April 6, 2010 @ 10:10 pm

  4. I’ve been hearing for a long time that high-fructose corn syrup is bad for you, but I’ve never read anything that connected it to fatty-liver disease. SCARY! I have read though that the liver treats fructose much the same way it treats alcohol. That is, it stops all metabolism of other nutrients until it can metabolize the fructose. I guess your body knows what’s good and what’s bad and wants to get rid of that bad as fast as possible.


    Comment by danapod — April 14, 2010 @ 9:14 am

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