With the average pediatrician visit lasting 18.5 minutes, parents may not be getting all the facts from their children’s doctors. Given the declining health and increase in chronic disease among American children, doctor visits may be consumed by bloodwork and presentation of test results, without much time left for discussing those results. One test result that may not receive appropriate attention is that of high iron levels.
Because a parent has primary responsibility for her child, she should always do her homework for doctor visits and come prepared with questions, particularly about test results and medications. If a child’s bloodwork indicates levels of iron high enough to cause the doctor to be concerned, one question a parent should ask the doctor is whether impaired liver function may be at the root of the problem.
Obesity, including childhood obesity, has many comorbidities — health impairments that accompany it — including a disorder known as non-alcoholic fatty liver disease (NAFLD). Prior to the modern era, in which one of every three children is overweight, liver disease was an ailment mainly confined to alcoholic adults. Now, however, physicians are seeing children with obesity-related liver disease in increasing numbers. According to research published in the June 2009 issue of Pediatric Health, NAFLD is the most common cause of liver disease in children. NAFLD occurs when macrovesicular fat accumulates in hepatocytes (liver cells) and impairs the liver’s ability to function. The researchers warn that the odds ratio of children with NAFLD either dying or receiving a liver transplant is 13.6 percent.
Even when children with NAFLD do not end up dying or receiving a donated liver, however, numerous health problems can present themselves. One such problem is impaired metabolism of iron, which shows up on blood tests as elevated iron levels, and on physical examination by such symptoms as discolored teeth. According to research published in 2008 in the American Journal of Clinical Nutrition, “mild iron overload is frequently observed in NAFLD,” and “may result from an impaired iron export due to downregulation of ferroportin-1 and ineffective hepatic iron sensing, as indicated by low hemojuvelin expression.” In other words, NAFLD harms the liver’s ability to produce a crucial iron export protein, leaving too much iron circulating in the blood.
One interesting result of elevated iron levels is an increase in the biosynthesis of cholesterol, leading to higher levels of serum cholesterol. In recent decades, doctors have cited a link between high serum cholesterol levels and heart disease, but it is possible that this link is an artifact of the link between the underlying disorders (obesity and NAFLD) and heart disease. If this is the case, then using drugs (such as statins or PCSK9 inhibitors) to lower cholesterol levels will have a negligible effect on cardiovascular disease, given that these drugs do not alter the underlying obesity and liver disease.
Many doctors are reluctant to discuss childhood obesity with patients and their parents, perhaps because they are overweight themselves, or because of fears of being accused of “fat-shaming.” No one would accuse a doctor setting a broken bone of “broken-bone-shaming”; no one should accuse a doctor advising a patient on achieving better health of any type of “shaming.” If a parent is concerned about her child’s weight, but her family doctor has not broached the subject, that parent can spend a few minutes with the Mayo Clinic’s online BMI calculator and present the doctor with the results to initiate a conversation. With dietary changes aimed at improving nutrient density and reducing calories, and by adding 60 minutes per day of cardiovascular exercise, childhood obesity can be reduced and even eliminated. Good parenting demands nothing less.