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NASH Causes & Risk Factors

Researchers do not know the exact cause of nonalcoholic fatty liver disease. They do know that you’re more likely to develop NAFLD – either simple fatty liver or NASH – if you:

  • Are overweight or obese
  • Have type 2 diabetes or pre-diabetes
  • Have abnormal levels of fats in your blood, which may include high levels of triglycerides, high levels of “bad” (LDL) cholesterol, or low levels of “good” (HDL) cholesterol
  • Have metabolic syndrome. This is a mix of conditions linked to being overweight or obese, and makes you more likely to get type 2 diabetes and heart disease. In order to be diagnosed with metabolic syndrome, any three of the following conditions must be present:
    • Large waist size
    • High blood pressure
    • High blood sugar (glucose)
    • High levels of triglycerides in your blood
    • Low levels of “good” (HDL) cholesterol in your blood


NASH is more likely to occur in people who…

  • Are older (although children can also get it)
  • Have type 2 diabetes
  • Are Hispanic or Asian
  • Have high blood pressure
  • Are post-menopausal women
  • Are obese with body fat concentrated around the waist
  • Have obstructive sleep apnea


There are also some less common reasons why you may get NAFLD or NASH, including…

  • Rapid excessive weight loss
  • Certain infections like hepatitis C
  • Medical conditions that cause your body to use or store fat improperly
  • Taking certain medications, such as:
    • Glucocorticoids
    • Synthetic estrogens
    • Amiodarone (Cordarone, Pacerone)
    • Methotrexate (Rheumatrex, Trexall)
    • Tamoxifen (Nolvadex, Soltamox)
  • Exposure to certain toxins
  • Polycystic ovarian Syndrome (PCOS) a health condition that can affect a woman’s menstrual cycle, fertility and hormones

Can children get NAFLD or NASH?


Much like adults, children who have certain health conditions like obesity and conditions related to obesity – type 2 diabetes/pre-diabetes, high blood pressure, and abnormal levels of cholesterol – are at risk for developing NAFLD and NASH. Experts don’t know why some children with NAFLD have simple fatty liver while others have NASH. Research suggests that NASH is more common in children who have both NAFLD and type 2 diabetes. In addition, certain genes may also increase a child’s chance of developing NASH.

How common are NAFLD and NASH in children?

NAFLD is the most common cause of chronic liver disease in children in the United States. Researchers estimate that close to 10 percent of U.S. children ages 2 to 19 – about six million children – have NAFLD. It’s become more common in children in recent decades, in part due to the growing epidemic of childhood obesity.

NAFLD is more common in…

  • Older children than in younger children
  • Hispanic and Asian American children, followed by Non-Hispanic White children (and less likely in African American children)

NAFLD is more common in boys than in girls; however, among children with NAFLD, boys and girls are equally likely to have NASH.

The majority of children with NAFLD have simple fatty liver. Children with simple fatty liver typically don’t develop liver complications. However, compared with adults who develop NAFLD, children with NAFLD are more likely to have NASH and related complications or liver disease as adults.

The good news is that fatty liver disease can be controlled or reversed with smart changes to your child’s lifestyle. It’s important to be aware of the risk factors associated with fatty liver disease and take steps to lessen your child’s chance of getting it, or keep it from progressing if your child has been diagnosed with the disease.

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