Caitlin Whyte (Host): Welcome to UK HealthCast from UK HealthCare. I'm your host, Caitlin Whyte. Nonalcoholic fatty liver disease is the most common chronic liver disease among children and teenagers, often linked with obesity and diabetes. And here at UK HealthCare, we have an entire clinic dedicated to treating and managing it.

We are joined by two lovely guests today to tell us more. Dr. Samir Softic is a physician at UK HealthCare's Pediatric Fatty Liver Clinic, and Morgan Garrett is a nurse practitioner at Kentucky Children's Hospital. Thank you so much for being here today.

So Morgan, I'll start with you today. Can you tell us what fatty liver disease is and the signs and symptoms for it?

Morgan Garrett: Sure. So, fatty liver disease is simply the accumulation of fat droplets, which are mostly consisting of triglycerides within the hepatocytes. And hepatocytes are the main cells that make up the liver. There is a more severe form of fatty liver disease that's called NASH or nonalcoholic steatohepatitis, which is sometimes more common in adults, but can be very prevalent in children as well.

With NASH, it actually can cause hepatomegaly or enlarged liver, and it can cause significant damage to the liver from those fat deposits. Patients with NAFLD are typically asymptomatic, but there can be some signs and symptoms, but typically they're very vague. Some of those symptoms are things like fatigue, general malaise, right upper quadrant pain, or epigastric fullness. Some of the signs and symptoms for NASH or that more severe form of the disease are often more severe as well and those things include ascites or swelling in the belly, itchy skin, shortness of breath, swelling of the legs, splenomegaly, and oftentimes kind of at the very end of that disease process we see jaundice or yellowing of the skin. Now, those symptoms are much more severe and typically by the time we see those that means our liver disease has progressed pretty significantly.

Host: Well, great, Morgan. Thank you for that explanation. And Dr. Softic, why is fatty liver disease becoming so common in Kentucky's kids?

Dr. Samir Softic: Thank you for the question. Fatty liver disease is tightly linked with the prevalence of obesity. And unfortunately, Kentucky is leading the nation in pediatric obesity. According to Robert Wood Johnson Foundation in 2021, Kentucky had the highest prevalence of pediatric obesity. Currently, it stands to be at a number two, but still there's lots of room for improvement.

Besides obesity, metabolic dysfunction in forms of type 2 diabetes and insulin resistance are important metabolic risk factors, and these diseases are also highly prevalent in Kentucky. Lastly, perhaps the common denominator of all of these conditions is a poor diet, and Kentucky has the highest density of fast food restaurants per capita in the nation, so there is a lot stacked against Kentucky.

Host: Gotcha. So Morgan, tell us more about the risk factors of fatty liver disease, please.

Morgan Garrett: Sure. So, something that Dr. Softic and I probably want to mention first is nonalcoholic fatty liver disease has recently been going under a renovation of name, if you will. We're actually going to be changing that name to metabolic dysfunction-associated steatotic liver disease or MASLD. We know that's quite a mouthful, but that name actually better characterizes the risk factors and some of the causes of fatty liver disease.

Some of those risk factors include things like having a family history of fatty liver disease, type 2 diabetes, and cardiovascular disease. Another one would be obesity, especially in children who are above the 99th percentile for BMI, which most of our patients in clinic are. Another one would be dyslipidemia, and that includes elevated total cholesterol, elevated triglycerides, low HDL, and elevated LDL. Some other risk factors include having hypertension, insulin resistance, type 2 diabetes, hypothyroidism, hypopituitarism, polycystic ovarian syndrome, sleep apnea, or other disordered breathing spells during sleep such as snoring, and other metabolic syndromes.

Host: And Dr. Softic, what can parents, adults, other guardians be doing to improve their child's liver and overall health?

Dr. Samir Softic: The first thing to do is to get screened. As Morgan mentioned, fatty liver disease is often silent, so there are no symptoms unless we check those liver enzymes. Also, fatty liver disease runs in families. So, talking to, you know, family members and getting that history is very important. Next thing would be to improve diet, since that tends to be a very important factor, we in our clinic focus on reduction of sugar-sweetened beverages, perhaps because that's the easiest thing to do, but also reducing intake of overall fats and improving intakes of fruits and vegetables is very important. Last is increasing physical activity. Physical activity likely is not going to be a significant contributor to weight loss, but even without weight loss, physical activity can improve metabolic health. So, that's very important, is to stay active as much as possible.

Host: Of course. Well, as we wrap up today's episode, let's turn our focus to UK HealthCare's Pediatric Fatty Liver Clinic. Morgan, how can the clinic help prevent issues like this?

Morgan Garrett: So, one of the really great things about our clinic is we screen children early and often, and we receive referrals from several other subspecialties around UK HealthCare, such as our BMI clinic, our gastroenterology clinic, endocrinology, and other primary care offices from around the region. So, we provide comprehensive education during our visits on lifestyle changes that include diet, exercise, sleep, and also mental health. This education comes from our providers mostly, but we also do have a full dietary staff who meet with our patients each visit. And they go over the important lifestyle modifications for increasing fruits and vegetables, decreasing sugary beverages, giving families recipes, and really great resources to be able to make those changes.

I would say probably the most important thing that we do for prevention, and taking care of our kiddos is that we follow up with kids every two to three months at the beginning and we really support them through these changes. So during our consult visit, we will screen each family, and ask about history of fatty liver and recommend screening for siblings over 10 years of age as well.

Caitlin Whyte (Host): Wonderful. And Dr. Softic, how can UK HealthCare's Pediatric Fatty Liver Clinic help when a child is diagnosed with a problem?

Dr. Samir Softic: Well, we are fortunate to have the first and only multidisciplinary clinic in the state of Kentucky with a mission to help children with fatty liver disease. So, our clinic is focusing on screening for these issues and specifically assessing for the presence of liver fibrosis. Liver fibrosis correlates with the poor outcomes, so if we identify a child with a significant liver fibrosis, then we offer more of our innovating pharmacotherapy. And so, that's one unique feature about our program is that we are at the forefront of delivering care to these patients, but also finding new ways of treating this disease.

Host: Well, thank you both for taking the time out of your busy schedules to meet with us and tell us all about the clinic. For more information, please call Kentucky Children's Hospital at 859-323-5000. And thanks for listening to UK HealthCast, a podcast from UK HealthCare. Please remember to subscribe, rate, and review this podcast and all of the other University of Kentucky HealthCare Podcasts. I'm Caitlin Whyte.