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Obese adolescents susceptible to liver disease, studies find

Rating

2 Star

Obese adolescents susceptible to liver disease, studies find

Our Review Summary

This was an alarmist piece that focused on the number of children needinig liver transplants for non-alcoholic fatty liver disease.  The story indicated that testing for the condition was inadequate and that more testing should be done.  But the story provided no insight into the magnitude of benefit that might be gained through either weight management or liver transplantation, or the risks or the costs associated with any treatment option.  

This story engaged in disease mongering, presenting data that exaggerated the prevalence and severity of the condition in children and that provoked fear in the reader. The article says that 2 to 5 percent of kids over age 5 may have non-alcoholic fatty liver disease, but then says as many as 10 percent of children and half of obese children have it. "It" being a very mild and early form of the condition that may or may not lead to long-term problems. There is a lack of evidence to show whether or not non-alcoholic fatty liver disease is a true concern for most people, or whether it is only a concern for some people — and if so, for whom.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The costs associated with liver transplantation were not provided beyond the sense that they were out of reach for a family of modest means without medical insurance.

The costs associated with the recommendation that pediatricians include liver testing as a routine part of patient care was also not discussed. 

Lastly – there was no discussion of the costs for behavioral treatment programs designed to better enable children and their families lose weight. 

All of these approaches have costs; no such costs were explained.  

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story did not quantify how effective liver transplants are or how effective various treatments are at reducing non-alcoholic cirrhosis of the liver.  While the two cases reported on were said to demonstrate relief of symptoms – one child being treated with a liver transplant and the other child being treated with lifestyle change – the story did not indicate how successful either approach was in a broader population.  Although it mentioned that the boy who had the liver transplant had not been successful with his weight loss efforts to date, there was no discussion about what that might mean in terms of longer term prognosis for his new liver.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

While mentioning that one child with cirrhosis was able to reduce the number of medications he needed from 11 to 4, the story did not provide any information about side-effects and potential harms associated with liver transplantation.  In addition, the story indicated that this child had failed to lose weight after the transplant, though it failed to discuss that the high dose of steroids after transplant needed to avoid organ rejection likely contributed to this situation.  Lastly, as liver transplant just replaces the diseased liver but doesn’t change the underlying circumstance that lead to the condition – the story should have discussed the potential future need for organ replacement.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story mentioned that ‘Some experts think as many as 10 percent of all children and half of those who are obese may suffer from it’.  However it neglected to inform the reader about the source of these estimates. And if only some experts believe these numbers to be true, what is the basis of belief for the other experts?   Further – while the increased incidence of obesity in children will mean that more children will develop cirrhosis, this does not translate into all of these children requiring liver transplants in order to survive. There is a lack of evidence to show whether or not non-alcoholic fatty liver disease is a true concern for most people, or whether it is only a concern for some people — and if so, for whom.

Does the story commit disease-mongering?

Not Satisfactory

This story engaged in disease mongering.  Cirrhosis of the liver is a serious condition and though its incidence appears to be on the rise in seriously obese children, liver disease should not be the top concern for parents of children who are overweight or simply obese.  The story made it sound as though all children with cirrhosis will require a liver transplant.

It presented data that exaggerate the prevalence and severity of the condition in children and provoke fear in the reader. The article says that 2 to 5 percent of kids over age 5 may have NASH, but then says as many as 10 percent of children and half of obese children have it. "It" being a very mild and early form of the condition, that may or may not lead to long-term problems. Cirrhosis and the need for liver transplant remain very rare conditions in children.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story included quotes from a number of physicians involved in the treatment of liver disease and liver transplantation as well as quotes from two mothers of patients and one patient himself.

The story would have benefited from having a clinician who would have summarized the big picture for readers. 

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The discussion of treatment options for non-alcoholic cirrhosis of the liver in pediatric patients was way out of balance in this story.  It focused on liver transplantation as though that was the appropriate first option.  While the story did mention obesity increasing the risk of developing the condition and did wrap up with a vignette about a boy whose condition responded to lifestyle interventions that resulted in weight loss, it failed to discuss what the expectations would be for weight loss to resolve the condition in youngsters.  It briefly discussed trials of metformin and vitamin E but gave no details.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story discussed several approaches to treatment.  It focused on liver transplantation and indicated that livers were in short supply.  It indicated that weight loss was a means to stop progression of the condition and may be an adequate approach.  It also mentioned that there are a number of clinical trials being conducted for treatment of cirrhosis.

Does the story establish the true novelty of the approach?

Satisfactory

The story captured the exploration of different approaches to tackle the problem.

Does the story appear to rely solely or largely on a news release?

Satisfactory

Does not appear to rely on a press release.

Total Score: 4 of 10 Satisfactory

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