SAN ANTONIO — About 100 million people in the United States are estimated to have non-alcoholic fatty liver disease. It is the most common form of liver disease in children and has more than doubled over the past 20 years.

"Non-alcoholic fatty liver disease is the liver manifestation of the metabolic syndrome," said Dr. Naim Alkhohri, a transplant hepatologist at University Hospital who also sees patients at the Texas Liver Institute. He says the disease can show up in kids and adults. Dr. Alkhohri told us, "It's related to eating non-healthy food and having a sedentary lifestyle and then gaining weight and the fat can accumulate within the liver."

To catch it early, a primary doctor must to lab tests to check for elevated liver enzymes. But the disease is often asymptomatic. "The most common symptoms are fatigue. So excessive tiredness and sometimes pain on the right side where the liver is," Dr. Alkhohri said.

But symptoms often don't show up until the disease is in advanced stages. Dr. Alkhori added, "About one-third of patients with fatty liver disease have an entity we call nonalcoholic steatohepatitis or sometimes we call NASH and these are the patients that I worry about."

Those are patients at risk for developing liver cirrhosis and end-stage liver disease, many requiring a liver transplant. Some of the risk factors for fatty liver disease include obesity, high blood sugar, type two diabetes, high cholesterol, and an underactive thyroid. But there is also family history and a genetic predisposition to the condition. Dr. Alkhori said, "We know Hispanics and Latinos have a higher prevalence of fatty liver disease compared to African-Americans that have the same degree of obesity and type two diabetes."

For adults, the national average for those with fatty liver disease is about 30 percent, and for children, the average is about 10 percent. 

But, in San Antonio those numbers are much higher. About 45 percent of adults here have fatty liver disease, and for children, that's 20 percent or twice the national average.