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Obesity and Liver Disease in the Hispanic Community

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A combination of heredity and diet is driving a potential health crisis of liver disease in the Hispanic community.

Obesity is a growing problem among Hispanics, especially children and adolescents. In Los Angeles County, obesity levels among Hispanics are among the highest (25.5 percent), especially hitting those with low incomes. In some communities, some 35 percent of children are obese.

Obesity is closely associated with non-alcoholic fatty liver diseases, which can range from simple accumulation of fat in the liver to irreversible scarring, a condition known as cirrhosis. Excess fat in the liver can lead to the development of Type 2 diabetes, a chronic disease, and over time to liver failure, cancer and death. In Los Angeles County, liver disease is the fourth leading cause of death among Hispanics men.

Particularly worrisome is that levels of liver fat are increasing among obese Hispanic children and adolescents. Fatty liver disease, an ailment traditionally associated with middle age, has become more evident in Hispanic youth. A study done by the USC Childhood Obesity Research Center found that 38 percent of obese Hispanic children and adolescents in Los Angeles have liver fat levels indicating the presence of nonalcoholic fatty liver diseases.

Mounting evidence suggests that Hispanics are genetically predisposed to fatty liver disease, compounding the health risks. An estimated 49 percent of the Hispanic population, compared to 23 percent of whites and 17 percent of blacks, carry a gene associated with higher liver fat content up to twice normal levels. Imaging studies show that the effect of this gene can be observed in Hispanics as young as 8 years old.

Combine this genetic predisposition with Hispanics' increased consumption of sugar -- especially of fructose -- and you have the makings of a health crisis.

Fructose, also known as "fruit sugar," naturally occurs in most fruits. In this form, the sugar is safe for humans because the fiber-rich flesh of most fruits slows down absorption of fructose as the sugar breaks down.

There are no such protections in a relatively new source of the sugar: high fructose corn syrup, which is made from highly processed cornstarch. High fructose corn syrup is now the preferred sweetener in the food industry because it is much cheaper to produce and much sweeter than ordinary table sugar. It is also increasingly added to many processed foods and is found in bread, cookies, breakfast cereals, chips, yogurt and sports drinks.

Here's the problem: Fructose is quickly converted into fat in the liver, setting the stage for fatty liver disease when consumed in abundance. Complicating matters is that we really don't know how much fructose is present in foods and drinks because high fructose corn syrup can have varying levels of the sugar. In a recent study, we found that in some soft drinks, especially popular drinks like Coca-Cola, Sprite and Pepsi, levels of fructose were 20 percent higher than expected and 30 percent higher than if they were made with ordinary sugar.

What should be done?

National industry standards should be toughened to require disclosure of more information on food labels. Currently, manufacturers are only required to disclose high fructose corn syrup as an ingredient; they do not have to reveal the exact amount of fructose in their products. That's problematic because of the known risks of consuming too much fructose.

In the absence of specific label information, Hispanic parents should limit their children's overall sugar consumption. Even table sugar, or sucrose, is 50 percent fructose. And they should avoid any drink, cereal, bread, infant formula, baked good and so on whose label says it contains high fructose corn syrup, especially if their children are obese or overweight. The fructose content in high fructose corn syrup can be as high as 65 percent.

Adults, of course, should be equally vigilant about what they consume.

Public health officials also have a role to play. They should culturally tailor educational programs for the Hispanic community about the dangers of overconsumption of sugar and high fructose corn syrup in particular. In addition, health officials should launch a genetic-screening program to identify Hispanics, especially the young, predisposed to develop fatty liver diseases.

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