Nonobese adolescents may be an underrecognized risk group for non-alcoholic fatty liver disease (NAFLD), according to recent research.

Praveen Selvakumar, MD, a pediatric gastroenterologist at the Cleveland Clinic, and colleagues penned an editorial to this effect in the Journal of Pediatric Gastroenterology and Nutrition.

A study led by Selvakumar and published in the same journal analyzed nationally representative data spanning 2005 to 2014 regarding 1,482 lean 12- to 18-year-olds. On average, 8% of them were suspected of having fatty liver disease.

Factors associated with a higher risk of suspected NAFLD included various indicators of metabolic syndrome, such as low HDL (good) cholesterol, high triglycerides and insulin resistance.

“NAFLD could be considered in lean adolescents with elevated ALT [liver enzymes], especially when associated with metabolic syndrome components and other [causes] of elevated ALT have been ruled out,” Selvakumar and colleagues wrote.

Selvakumar believes that multiple factors likely drive NAFLD in lean adolescents, including excess abdominal fat, which can prompt insulin resistance. Additionally, some young people may be genetically predisposed to the condition.

To combat fatty liver in adolescents, Selvakumar recommends weight loss: A 10% loss in body weight generally improves the condition. Avoiding excess carbohydrates, simple sugars, candies and juices; reducing portions and calorie intake; and following a Mediterranean diet may also help. In addition, both aerobic activity and resistance exercise can led to a decrease in liver fat.