A growing health crisis in Israel

"Fatty liver disease occurs when fat infiltration in the liver exceeds normal levels," according to Ishach-Adiv. "In early stages, it may cause inflammation. In advanced cases, it can lead to fibrosis, cirrhosis and even life-threatening complications such as liver cancer."

Previously linked mainly to alcohol consumption, the condition is now recognized as part of a broader metabolic disorder encompassing obesity, diabetes, hypertension and cardiovascular diseases. It is classified as Metabolic Associated Liver Disease (MASLD).

"This is a growing epidemic in the Western world," Ishach-Adiv warns. "It's part of a surge in non-communicable diseases, including cardiovascular conditions, diabetes, hypertension, autoimmune disorders and chronic inflammatory diseases."

Childhood obesity has surged in recent decades, leading to a parallel increase in fatty liver disease among children. Ishak-Adib, with 30 years of experience, notes a dramatic rise in pediatric cases.

"I never saw this in my early career," she says. "Now, it’s common — even in children without excess weight. Among obese children, up to 40% develop fatty liver disease. I currently treat five- and eight-year-olds with the condition, something unheard of in the past. It used to be rare to diagnose a 15-year-old with fatty liver disease, but today it's routine."

Modern diets high in processed foods, saturated fats, sugary drinks and red or processed meats, alongside a decline in physical activity, contribute significantly to the rise in fatty liver disease among children.

"Western diets are overloaded with processed foods and unhealthy fats, while intake of vegetables, fruits, legumes and whole grains remains low," Ishach-Adiv explains. "It’s not just about what we eat—it’s also about what we don’t do. Kids today move less than ever. A sedentary lifestyle, with excessive screen time and little physical activity, directly impacts energy balance."

Although genetics can play a role, it is not the primary cause. "Some cases stem from genetic disorders, but these are rare," she says. Furthermore, even children with normal or low BMI can develop the condition if they have insulin resistance, high blood lipid levels or a genetic predisposition.

Fatty liver disease is often called a "silent disease" because it typically has no noticeable symptoms. "A child or adult can have fatty liver disease without realizing it," Ishach-Adiv says. "It develops quietly and doesn’t cause discomfort until complications arise."

The condition is often detected through routine checkups, particularly in overweight children or those with unexplained symptoms.

"Ultrasounds combined with blood tests can reveal fatty infiltration in the liver. Elevated liver enzymes in blood tests may also signal the disease," she says. "Sometimes, children are diagnosed after being examined for unrelated stomach pain." Early detection is crucial, as lifestyle changes can prevent irreversible damage.

Fatty liver disease isn’t a life sentence — it’s a warning sign. "I tell families that this is an opportunity to make changes before it’s too late," Ishach-Adiv stressed. "It’s a chance to adjust not only the child’s habits but the entire family’s. Many times, siblings and parents also adopt healthier lifestyles."

The primary treatment isn’t medication but dietary and lifestyle modifications. "Some children with severe obesity or metabolic syndrome may receive weight-loss treatments and there are options for adults. However, the best long-term solution remains a healthy diet and regular physical activity," she says.

Dietary recommendations include shifting from processed foods to a more natural, Mediterranean-style diet rich in vegetables, fruits, legumes and whole grains. "Reducing animal fats, avoiding preservatives and artificial colors and prioritizing plant-based fats significantly improve liver function in children," she explains.

The earlier the intervention, the easier it is to maintain healthy habits. "Convincing a 15-year-old to stop drinking chocolate milk and eat healthily is challenging," Dr. Ishach-Adiv says. "But if healthy eating habits are instilled early, they become second nature."

"Our bodies send warning signals—we just need to listen and act before irreversible damage occurs," Ishach-Adiv concludes.