COULD OXYGEN HALT THE PROGRESSION of Non-Alcoholic Fatty Liver Disease ?
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“ The factors driving obesity don ’ t live within the confines of the hospital ,” says Shikha Sundaram , MD , pediatric hepatologist at Children ’ s Hospital Colorado . “ They live in the confines of the worlds in which each patient lives . Unfortunately , by the time we see them , their obesity-related , non-alcoholic fatty liver disease ( NAFLD ) may be fairly progressed .”
According to the Centers for Disease Control and Prevention , approximately 15 percent of U . S . children are obese ; 30 percent of those kids have NAFLD , which may lead to swelling , inflammation , cirrhosis , cancer , or liver failure . NAFLD has become the number one reason for referral to the Pediatric Liver Center at Children ’ s Colorado , and , according to Dr . Sundaram , is likely to surpass viral hepatitis as the number one reason for all liver transplants in the U . S .
The most effective treatment for NAFLD is slow and steady weight loss and exercise , but that is not an easy treatment , Dr . Sundaram explains .
“ The reality is that success in helping patients lose weight and keep it off isn ’ t very good – that ’ s not just Children ’ s Colorado , that ’ s any hospital . It ’ s a hard thing for families to understand – why losing weight and exercise is their only proven treatment option .”
Instead of surrendering to an inevitability – that more children will acquire NAFLD and might need a transplant , for which there will be fewer healthy livers – Dr . Sundaram is studying the nuances of the disease to figure out how to halt its progression .
In particular , she is investigating how nocturnal hypoxia and sleep apnea may affect the liver in
3,600 +
SLEEP STUDIES A YEAR ARE CONDUCTED BY THE SLEEP CENTER AT CHILDREN ' S COLORADO
patients with NAFLD . Dr . Sundaram already knew that when patients who had a liver transplant experienced low oxygen levels , it resulted in injury to their new organ ; she wondered if the same thing was happening in patients with NAFLD . If it did , perhaps they could interrupt the injury ’ s progression with effective nighttime breathing treatments .
So far , Dr . Sundaram and her colleagues have proven her hypothesis correct by conducting sleep studies with co-investigator Ann Halbower , MD , of the Children ' s Colorado Sleep Center . On children who had NAFLD ( determined through liver biopsy ), they found that those who experienced nocturnal hypoxia also had progression of their liver disease , especially as the hypoxia became more severe .
They are now studying if they can slow or stop the progression of NAFLD through the nighttime use of continuous positive airway pressure ( CPAP ) to raise oxygen levels .
“ Wearing CPAP is not an easy thing for kids , but it ’ s certainly easier than weight loss , which can be a real struggle for children ,” Dr . Sundaram says . “ Maybe this is one way we can take away at least one of the insults to their liver .”