By: Ada Chong
July 2022
The Gastroenterology, Endocrinology, Nutrition Innovation (GENI) Center launched in January 2022 and is on a mission to help kids live healthier and more productive lives. Saul Karpen, the director of this pediatric research center focused on metabolic health, plans to bring faculty members together through this integrative hub for gastroenterology, endocrinology, and nutrition research to address the growing epidemic of childhood obesity and type 2 diabetes.
As we have more obese childhood populations, we have more complications in many organs including the liver. Pediatricians have seen more elevated liver tests which suggests there’s damage and altered function in the liver. Recent estimates show 1 in 3 adults in the United States have non-alcoholic fatty disease (NAFLD), often a consequence of obesity and the central role for the liver in handling ingested food and possible toxins. The liver is a natural place to stress fat, and the stress of obesity and certain diets can increase the amount, and alter the types of fat that accumulates in the liver. Dr. Karpen says some people are predisposed to not be able to handle excess fat in their liver. This can result in scarring in the liver and liver functions not working as well as it should.
The liver is a major organ that processes sugars and converts this to various types of fats. The amount of sugar someone eats can lead to the development of diabetes, especially in those who are overweight or predisposed to developing NAFLD. Dr. Karpen says there’s an uptick in type 2 diabetes in the adult and pediatric world and liver disease is now the #1 reason people need a transplant in this country. Drugs are not yet available for adults and children to address NAFLD and eating less and exercising more is often not enough.
Currently, there’s about 50 faculty members who are a part of GENI. GENI wants to engage and provide novel interactions of pediatricians and pediatric researchers with physicians who take care of adult patients, so the Center can learn more about the ramification of diabetes and cardiovascular disease. This information will help pediatricians learn about the features of the endocrine system in kids they should focus on and which patients they need to have closer observation on. Pediatricians can struggle with learning who is at risk versus who is not at risk. Dr. Karpen hopes to find biomarkers that can be identified in Atlanta and figure out who’s at risk, so pediatricians can get at-risk patients into exercise and nutrition programs as well as clinical trials for the soon-to-be expected drugs that will be available.
GENI hopes to receive support so they can study cohorts of lean and non-lean patients, kids who are mildly affected, and kids who have lab tests or ultrasounds that are abnormal. The Center also wants to study groups of kids at risk such as those with Hispanic or Asian ancestry, often who may develop NAFLD even in those who have a lean disposition. To get data on this research in the future, Dr. Karpen plans to get information from blood tests that look for proteins and fats that may be correlated with heart disease and diabetes as well as tracking patients during their semi-annual or annual visits. Children’s also has a special Fibroscan machine that measures the amount of scarring and fat in the liver, in a noninvasive way during routine clinic visits.
Dr. Karpen’s passion stems from being worried about the next generation. He says the next generation is physically different than the more recent generations. He says, “I don’t want to run into someone 20 years from now and they tell me that I saw their kid and now they have end stage liver disease or diabetes out of control. I went into medicine to make a difference.”
The GENI Center looks beyond metabolic diseases. Dr. Karpen says there’s no other home in our institution for disease research on gastroenterology, hepatology, and endocrinology. The next step is getting the right people to join the Center. Dr. Karpen hopes to be fully funded so in the next 5-10 years the GENI team can use their expertise to develop large scale grants to help them understand what’s different about these kids who face childhood obesity, and to provide a way to provide them with healthy and fruitful long lives.