17. Obesity and its Hepatic Complications in Adults and Children
- E. Jenny Heathcote MB, BS, MD, FRCP, FRCP(C)4,5,6,7
Published Online: 4 SEP 2012
Copyright © 2012 John Wiley & Sons, Ltd
Hepatology: Diagnosis and Clinical Management
How to Cite
Heathcote, E. J. and Roberts, E. A. (2012) Obesity and its Hepatic Complications in Adults and Children, in Hepatology: Diagnosis and Clinical Management (ed E. J. Heathcote), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118314968.ch17
Francis Family Chair in Hepatology Research, Toronto, Ontario, Canada
University of Toronto, Toronto, Ontario, Canada
Patient Based Clinical Research Division, Toronto Western Research Institute, Toronto, Ontario, Canada
University Health Network/Toronto Western Hospital, Toronto, Ontario, Canada
- Published Online: 4 SEP 2012
- Published Print: 12 OCT 2012
Print ISBN: 9780470656174
Online ISBN: 9781118314968
- insulin resistance;
- metabolic syndrome;
Rates of obesity in both children and adults continue to rise. Once more prevalent in the Western world, obesity has become a major health-care problem in the entire developed world. Thus it is important to routinely evaluate the body mass index (BMI) as part of the general medical examination (different scales are used for adults and children).
On average, 70% of obese individuals have fatty infiltration of the liver, often first identified on abdominal ultrasound. So-called non-alcoholic fatty liver disease (NAFLD) can be mistaken for alcohol-induced fatty liver biopsy (first described about 30 years ago). Close to 20% of obese individuals are found, on liver biopsy, to have both hepatic steatosis and ongoing inflammation with varying degrees of hepatic fibrosis (non-alcoholic steatohepatitis, NASH), which silently progresses to cirrhosis and even hepatocellular carcinoma. Even in those with established cirrhosis, individuals undergoing gastrointestinal bypass surgery may have complete disease regression where desired weight loss is achieved. It is also likely that some given a diagnosis of “cryptogenic” cirrhosis are cirrhotic as a result of former obesity. Even children with fatty liver disease may be cirrhotic. A high index of suspicion is required as symptoms and signs of cirrhosis are often lacking. Biochemical evaluation shows insulin resistance to be frequent, which is why the prevalence of type 2 diabetes is increasing worldwide, particularly in those with abdominal obesity. Type 2 diabetes may also resolve if body weight returns to normal. Hyperlipidemia is also a frequent finding in this population. Not surprisingly, death from coronary artery disease is still more likely than death from liver disease in this population. In addition, many malignancies are more likely in the obese, especially if they smoke.
If any individual, whether overweight or not, is found to have a low platelet count on routine screening this suggests cirrhosis is already present. Ultrasound examination (if the patient is not too large for the table) or use of a FibroScanor FibroTestwill confirm an underlying cirrhosis. If both confirm cirrhosis, an upperpanendoscopy should then be performed to check for signs of partial hypertension (i.e. variceswith or withoutascites). The only successful treatment for NAFLD is weight loss.