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TRENTON, N.J. — In a new and disturbing twist on the obesity epidemic, some overweight teenagers have severe liver damage caused by too much body fat, and a handful have needed liver transplants.

Many more may need a new liver by their 30s or 40s, say experts warning that pediatricians need to be more vigilant.

The condition, which can lead to cirrhosis and liver failure or liver cancer, is being seen in kids in the United States, Europe, Australia and even some developing countries, according to a surge of recent medical studies and doctors interviewed by The Associated Press.

The American Liver Foundation and other experts estimate 2 percent to 5 percent of American children older than 5, nearly all of them obese or overweight, have the condition, called non-alcoholic fatty liver disease.

"It's clearly the most common cause of liver disease," said Dr. Ronald Sokol, head of public policy at the liver foundation and a liver specialist at Children's Hospital and University of Colorado Denver.

Some experts think as many as 10 percent of all children and half of those who are obese may suffer from it but note that few are given the simple blood test that can signal its presence. A biopsy is the only sure way to diagnose this disease.

As fat builds up, the liver can become inflamed and then scarred over time, leading to cirrhosis, a serious condition, which in years past was mostly caused by hepatitis or drinking too much alcohol.

Liver failure or liver cancer can follow, but if cirrhosis has not yet developed, fatty liver disease can be reversed through weight loss.

The scope of the disease has only been realized in recent years. Just a handful of cases were reported in medical journals in the 1980s, and in the past, many adult patients were thought to be lying when they denied drinking alcohol.

The disease is most common in overweight children with belly fat and certain warning signs, such as diabetes or cholesterol or heart problems. But it's also been seen in a few children of normal weight.

Genetics, diet and exercise levels all play a role. It is most prevalent among Hispanics, relatively rare among African-Americans, and more common among boys than girls.

"There are people in their 30s or early 40s who will require a liver transplant" from developing the condition as children, predicted Dr. José Derdoy, head of liver transplants at Cardinal Glennon Children's Medical Center in St. Louis.

Experts blame obesity, with about two-thirds of all Americans overweight. As fatty liver disease is becoming more common in adults, many experts predict it will become the top cause of liver transplants by 2020.

"There aren't enough livers to go around," said Dr. Philip Rosenthal of the University of California-San Francisco Children's Hospital.

His patient, Irving Shaffino, a 15-year-old Mexican-American who lives outside Lubbock, Texas, was lucky to get a transplant a year ago. He was in end-stage cirrhosis and, at 5-feet-4 1/2, weighed 180 pounds.

Irving had been fat since age 6, thanks to a high-starch, high-fat diet of Mexican food, pizza and burgers, said his mother, Guadelupe Shaffino.

At age 8, she said, he had a distended stomach and by his early teens, breathing problems kept him tethered to an oxygen tank at home.

Without health insurance, the family couldn't find a local hospital that would do a transplant.

"My son begged me, 'Don't let me die, Mommy,' so I did everything in my power to find a place to help him," said Guadelupe, a restaurant cook. "Thanks be to God, we found a way."

UCSF Children's Hospital, with money from a state health program, agreed to do the transplant. Rosenthal, who oversees the hospital's pediatric-liver- transplant program, took over Irving's care.

Rosenthal said without a new liver Irving would have died, maybe within months. "He was in bad shape," the doctor said.

Soon after tests were completed and Irving got on a transplant waiting list, an organ was found.

Within a couple of months of the July 26, 2007, operation, Irving had weaned himself from the oxygen tank and could go on walks, although he got winded quickly.

Back home in Texas, his medications are down from 11 to four, and Irving said he's replaced soda and fast food with fruit, vegetables and whole grains.