For decades, fatty liver disease was considered a health problem seen mainly in adults. Now, doctors across the globe are witnessing a worrying trend. More children and adolescents are developing the condition, making it one of the fastest-growing chronic liver diseases in the young population. The occurrence is higher among overweight or obese children. Research shows that obesity among children and adolescents rose from about 4% in 1975 to 18% in 2016. As a result, fatty liver or metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most common chronic liver disease in children and adolescents worldwide, affecting about 5-10% of the paediatric population.

India is no exception. A school-based study of overweight and obese Indian children aged 11 to 15 years found that nearly 62% had fatty liver disease with no clear symptoms. Some reports suggest that 35% of Indian children may currently have fatty liver disease. Many of these children also had insulin resistance, elevated triglycerides or high blood pressure, highlighting the close relationship between liver disease and metabolic health.

A challenge with paediatric fatty liver disease is that it often develops quietly. Most children feel perfectly healthy and do not complain of symptoms. However, fat continues to accumulate within the liver, sometimes leading to inflammation and injury. If not screened, this ticking bomb can lead to serious health problems later in life, such as type 2 diabetes, cardiovascular disease and advanced liver disease.

The Real Drivers of Fatty Liver Disease

There is more to this increase in fatty liver cases than just fats. In paediatric cases, research identifies obesity and insulin resistance as the major drivers of MASLD. Diets high in sugary beverages, refined carbohydrates, ultra-processed foods and excess calories contribute to unhealthy weight gain and metabolic dysfunction. Physical inactivity and excessive screen time further increase risk. In a randomised clinical study of such adolescents, a low-free-sugar diet led to significant reductions in liver fat and improvements in liver health markers within only eight weeks. Other studies do not identify any single nutrient, such as dietary fat or cooking oil as the cause of fatty liver disease. Rather, the disease develops through a combination of excess calorie intake, metabolic dysfunction, genetic susceptibility and sedentary behaviour.

Hence, the primary goal to prevent fatty liver is not only weight loss but also better metabolic health and less abdominal fat. Diets that include fruits, vegetables, whole grains, legumes, nuts, seeds, fish and other nutrient-dense foods are beneficial. Healthy fats are necessary to make a diet balanced. Trans fats should be replaced with fats that have a balanced fatty acid profile and essential fatty acids, including omega-3 (fish oil, chia seeds, flax seeds, hemp seeds) and omega-6 (palm oil, soybean, walnuts, eggs, sunflower oil).

Tocotrienols, a Potential Game-Changer

While the population still needs to learn more about fats and their role in a balanced diet, scientists are studying naturally occurring bioactive compounds in fats that may support overall health. One such category of compounds is tocotrienols, a form of vitamin E found richly in palm oil, moderately in rice bran oil and uniquely in annatto seeds.

Palm oil is an oil with a balanced fatty acid profile. It is also one of the richest natural sources of tocotrienols. These forms of Vitamin E have antioxidant and anti-inflammatory properties and have shown promising effects in experimental studies of fatty liver disease in a review of animal and human studies. The reviewed studies suggested that tocotrienols may help reduce liver fat, improve liver health and lower inflammation and scarring.

While ongoing research may eventually establish tocotrienols as a useful nutritional aid in preventing or managing fatty liver disease, no supplement can deliver the benefits of balanced diet, regular physical activity, limited intake of processed foods, adequate sleep and reduced screen time. Such early lifestyle choices can have a lasting impact on the overall health of children. Homes and schools should promote healthier eating habits, encourage physical activity and limit children's exposure to sugary drinks and energy-dense foods. Communities and governments must also create environments that make healthy choices easier and more accessible for everyone.

(By Dr Saurabh Bansal, Gastrointestinal, Laparoscopic, Cancer and Robotic Surgery Specialist and Consultant at Apollo Spectra Hospital and National Heart Institute, New Delhi)