Why do so many Latino children develop fatty liver disease?

Saira Diaz uses her fingers to count fast food and sweets establishments located near the home in South Los Angeles, which she shares with her parents and her 13-year-old son. "There are one, two, three, four, five fast food restaurants," she says. "And a small shop specializing in the sale of snacks, sodas and sweets."

In this low-income, mainly Latin American neighborhood, it is very difficult for a child to avoid sugar. Last year, doctors at the St. John's Well Children's and Family Center, a non-profit community clinic seven blocks away, became alarmed by the growing weight of Diaz's son, Adrian Mejia. They persuaded him to join an intervention study by the University of Southern California and Los Angeles Children's Hospital (CHLA) that moves participants away from sugar to reduce the rate of obesity and obesity. diabetes in children.

It also targets a third condition that few people have heard of: fatty liver.

Linked to both genetics and diets high in sugars and fats, "hepatic steatosis tears the Latino community like a silent tsunami and particularly affects children," said Dr. Rohit Kohli, head of the gastroenterology department, said Hepatology and nutrition at CHLA.

Recent research has shown that about 1 in 4 people in the United States is suffering from fatty liver. But among Latinos, especially those of Mexican and Central American descent, the rate is significantly higher. A large study in Dallas found that 45% of Latinos had a fatty liver.

The disease, diagnosed when more than 5% of the weight of the liver is fat, does not cause serious problems for most people. But it can progress to a more serious illness called NASH, or NASH, which is linked to cirrhosis, liver cancer and liver failure. This progressive form of fatty liver is the cause of the fastest growing liver transplant in young adults.

The USC-CHLA study is led by Michael Goran, director of the CHLA Diabetes and Obesity Program, who made an alarming discovery last year: Sugar contained in sugary drinks can be passed on from breast milk to the child, which can predispose children to obesity. and foie gras.

Called HEROES, for a healthy diet based on reducing excess sugar, his program is designed to help kids like Adrian, who drank at least four sugary drinks a day, to get rid of unhealthy habits may lead to fatty liver and other diseases.

Fatty liver disease is gaining more and more attention in the medical community as legislators step up their pressure to discourage the consumption of sugary drinks. Sacramento lawmakers are considering proposals to impose a tax on sodas on a statewide scale, to put warning labels on sugary drinks and to ban beverage companies from booze. Offer vouchers on sugary drinks.

"I support sugar taxes and warning labels as a way to discourage consumption, but I do not think that alone will be enough," Goran said. "We also need public health strategies that limit the marketing of sugary drinks, snacks and cereals to infants and children."

William Dermody, spokesman for the American Beverage Association, said, "We understand that we have a role to play in helping Americans manage the consumption of added sugars. That's why we create more than drinks with less or no sugar. "

In 2016, 45 deaths in Los Angeles County were attributed to fatty liver. But this is a "gross underestimate", because at the time of death, people with cirrhosis are often affected by cirrhosis, and this is what appears on the death certificate, said Dr. Paul Simon, responsible scientist at the LA County Public Health Department

Still according to Simon, it is striking to note that 53% of deaths attributed in 2016 to hepatic steatosis are among Latin Americans, nearly double their proportion of the total number of deaths in the county.

Medical researchers consider hepatic steatosis as a manifestation of the so-called metabolic syndrome – a cluster of conditions including excess belly fat and high blood pressure, blood glucose and cholesterol that may increase the risk of disease heart attack, stroke and diabetes.

Until 2006, few doctors knew that children could get fatty liver disease. In the same year, Dr. Jeffrey Schwimmer, professor of pediatrics at the University of California at San Diego, examined autopsies of 742 children and adolescents aged 2 to 19 who died in a car accident or other cause. % of them had fatty liver disease. Among obese children, 38% had a fatty liver.

After the publication of the Schwimmer study, Goran began using MRI to diagnose fatty liver in the living child.

A 2008 study by another group of researchers pushed Goran further. She showed that a variant of a gene called PNPLA3 significantly increased the risk of contracting the disease. According to Goran, about half of Latinos own a copy of this high-risk gene and a quarter, two copies.

He started a new study, which showed that in 8-year-olds, those who had two copies of the gene at risk and who consumed large amounts of sugar had three times more fat in the liver than children without a copy of the gene. In the USC-CHLA study, he is currently investigating whether reducing sugar consumption decreases the risk of hepatic steatosis in children with the PNPLA3 gene variant.

At the beginning of the study, he tests the children to see if they own the PNPLA3 gene, uses an MRI to measure their hepatic fat and lists their sugar intake. A dietician of his team sensitizes the family to the impact of sugar. After four months, they again measure liver fat to assess the impact of the intervention. Goran expects the study to be completed in about a year.

More recently, Goran investigated the transmission of sugar from mother to baby. He showed last year that, in breastfeeding mothers, who drank beverages sweetened with high fructose corn syrup – the main sweetener in the standard formulations of Coca-Cola, Pepsi and other sodas – the fructose content in breast milk had increased and remained high for several hours, ensuring that the baby ingested it.

This early exposure to sugar could contribute to obesity, diabetes and fatty liver, according to previous research that had shown that fructose could increase the storage capacity of cells' fat, Goran said.

In neighborhoods like South Los Angeles, where Saira Diaz and Adrian Mejia live, the lack of full-service markets and fresh produce makes it difficult to eat well. "Access to unhealthy foods – which are generally cheaper – is very high in this city," said Derek Steele, director of health equity programs at the Social Justice Learning Institute in Inglewood, California , at Kaiser Health News.

The institute kicked off farmers' markets, helped convert two convenience stores into markets offering healthier food options, and created 109 community gardens on public and private lands in South LA and Canada. Inglewood, which has 125 liquor stores and convenience stores and 150 fast food restaurants.

At the Torrance Memorial Medical Center, 10 miles from the center, Dr. Karl Fukunaga, a gastroenterologist at Digestive Care Consultants, said he and his colleagues met so many patients with fatty liver that they were considering creating a clinic to fix it. He urges his patients to avoid sugar and reduce their consumption of carbohydrates.

Adrian Mejia and his mother received the same advice from a dietician from the HEROES program. Adrian gave up sugary drinks and fat from his liver dropped by 43%. Two months ago, he joined a football league.

"Before, I weighed a lot and it was hard to run," he said. "If I continued at the same pace as me, probably later in my life, I would be like my [diabetic] grandmother. I do not want that to happen. "

Kaiser Health New is an independent editorial program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan organization. health non-affiliated research and communication organization KaiserPermed. You can see the original report on his website. This story was first published on California Healthline, a service of the California Health Care Foundation.