All obese children ages 9 to 11 should be screened for non-alcoholic fatty liver disease (NAFLD), regardless of whether they are exhibiting any symptoms, according to new guidelines endorsed by the American Academy of Pediatrics (AAP). Experts say the condition currently affects as many as 38 percent of children with obesity in the United States, AAP News reports.

The clinical practice guidelines were drawn up by a panel of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition that includes 27 updated recommendations for screening, diagnosing, treating and long-term care of children with fatty liver disease. A follow-up report from the society noted that NAFLD has rapidly become the most common liver disease seen in the U.S. pediatric population over the last two decades.

Since children with NAFLD are often asymptomatic, the panel expanded screening protocol to all children ages 9 to 11 with obesity and other children with risk factors with an alanine aminotransferase test, which measures the amount of this liver enzyme in the blood. If levels are abnormal, the panel recommended additional tests, such as a liver biopsy, to determine whether fat deposits are present and to rule out any other liver conditions.

There are currently no medications or supplements available to treat NAFLD. For children diagnosed with the condition, the panel recommended improving their diet, avoiding sugar-sweetened beverages and increasing physical activity. The report also recommended that certain adolescents be considered for bariatric surgery—but only if they had severe health issues.

The panel also recommended periodic screening in children with fatty liver disease for elevated cholesterol levels and diabetes, vaccination against hepatitis A and B viruses (HAV and HBV) and monitoring children annually for disease progression. These children should also be regularly counseled about the dangers of binge drinking and smoking with their condition.