Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in Children

Overview

Metabolic dysfunction-associated steatotic liver disease (MASLD)* is the most common form of chronic liver disease among children and adolescents. MASLD used to be called nonalcoholic fatty liver disease, or NAFLD. It occurs when too much fat forms in the liver cells. Normally, the liver takes in food directly from the gut and processes fat, carbohydrates and protein into energy and other proteins. An imbalance in this process can result in excess fat in the liver.

MASLD is a group of conditions that occur in different stages:

1. Simple steatosis: fat builds up in the liver
2. Metabolic dysfunction-associated steatohepatitis (MASH), previously called nonalcoholic steatohepatitis (NASH): inflammation (swelling) in the liver caused by a buildup of fat
3. MASH with fibrosis: development of scarring in the liver
4. Cirrhosis: bumps (nodules) and hardening of the liver, usually due to long-term damage

Symptoms and Causes

Metabolic dysfunction-associated steatotic liver disease (MASLD) is caused by extra fat buildup in the liver. If MASLD worsens, it can lead to inflammation (swelling) of the liver. This is called metabolic dysfunction-associated steatohepatitis, or MASH.

Children may be at a higher risk for MASLD if they:

• Are overweight or obese
• Have insulin resistance (an increase in blood sugar)
• Have type 2 diabetes
• Eat an unhealthy diet and get little to no exercise
• Have abnormally high amounts of cholesterol or fats in the bloodstream (dyslipidemia)
• Have sleep apnea (irregular breathing pattern during sleep)

There can be an inherited (genetic) risk, but it is not known how often inheritance plays a role in the development of MASLD.

It is not always possible to prevent MASLD because there can be genetic or environmental factors involved. It is possible, however, to lower your child’s chances of developing MASLD. This can be done through helping them eat healthy foods, encouraging them to participate in some form of physical activity that they will enjoy, and controlling other existing medical conditions.

Often, there are no symptoms of MASLD in its early stages. It is more common for symptoms to develop once significant damage to the liver has occurred. Some symptoms of MASLD and MASH (previously called NASH) may include:

• Discomfort or pain in the abdomen (belly area)
• Fatigue (feeling very tired)
• Irritability
• Headaches
• Difficulty concentrating
• Depression and anxiety
• Changes in skin color near joints and the back of the neck/upper back

Diagnosis and Tests

There is no specific test for MASLD (previously called NAFLD). Most children are diagnosed with MASLD when it is identified through blood tests or ultrasound scans that are done to diagnose some other condition. In some (but not all) cases, a liver biopsy may be needed to confirm the diagnosis and assess the liver.

It is important to have an honest discussion with your child’s medical provider about their health and lifestyle because, as stated above, liver disease can have very few symptoms in its early stages. Additionally, other conditions that can seem like MASLD must be ruled out before a diagnosis can be made.  These conditions may include:

• Malnutrition
• Certain other diseases such as cystic fibrosis
• Artificial feeding such as feeding directly into a vein
• Certain medications

Management and Treatment

There are currently no approved medications to treat MASLD (previously called NAFLD), but we know the amount of fat in the liver can be reduced through weight loss, eating a healthy diet with limited junk food, and getting regular exercise. It is often helpful to schedule a few visits with a dietitian or nutrition expert to help with meal planning.

Helpful Nutrition Tips

• Children and adolescents should eat foods in portions that are appropriate for their ages. These amounts are smaller than those that an adult would eat.
• Check labels on the food you eat and know what the food you are eating contains. Foods often have hidden fats, sugars, and salt.
• Swap sugary drinks and breakfast foods for things like zero sugar/ low calorie drinks or whole grain cereals with no added sugar.
• Increase fiber intake by including beans and lentils in your child’s daily diet.
• Aim for five portions of fruit and vegetables a day.
• Avoid frying foods and try to grill, bake, or poach them instead.
• Encourage your child to drink water as his or her main fluid each day.

Activity and Lifestyle

Children and young people should have at least 60 minutes of physical activity a day.

Sleep is just as important as physical activity and healthy eating. Try to ensure that your child gets enough sleep. What can help children sleep is spending less time on the computer or electronic devices. Pediatricians recommend less than two hours of screen time a day. Experts also state that keeping all devices out of the bedroom and logging off at least an hour before bedtime can help children get a better night’s sleep. “Screen time” may be replaced with reading, coloring, or other non-tech activities.

Liver transplant

If the liver becomes damaged so much that it cannot work properly, a transplant may be needed.

Steatotic Liver Disease in Children: An Early Opportunity for Meaningful Change

This presentation by Rachel W Smith, MD and Jaime Chu, MD is an excerpt from the ALF 2021 Poster Competition.

View Presentation

Outlook and Prognosis

Children with MASLD (formerly called NAFLD) may have to remain in the care of liver specialists throughout their lives so that their liver health can be monitored on a regular basis. If MASLD is not controlled or reversed, it can worsen and lead to serious inflammation (swelling) of the liver and the development of scar tissue that replaces healthy liver tissue. Early scarring is called fibrosis, and advanced scarring is called cirrhosis.

Fibrosis and cirrhosis may be prevented if steps are taken to address MASLD as outlined in the Management and Treatment portion of this page.  If cirrhosis occurs, this means that hardened scar tissue has replaced much of the healthy liver tissue and the liver can no longer work properly. Complications can include liver failure, liver cancer, and the need for liver transplant. For more information about cirrhosis, visit https://liverfoundation.org/liver-diseases/complications-of-liver-disease/cirrhosis/.

Prevention

In many cases, MASLD (previoulsy called NAFLD) can be prevented through healthy diet and physical activity.

Living with MASLD

If your child is at risk for or has been diagnosed with MASLD (formerly known as NAFLD), it is very important that you speak to his or her healthcare provider about managing your child’s health.

Questions to Ask The Doctor

• What conditions does my child have that suggest MASLD?
• Can MASLD be reversed? How long can this process take?
• What kinds of lifestyle changes and diet can I make for my child?
• Can you connect me to a registered dietitian or nutritionist to help me with healthy meal planning for my child?
• What kinds of physical activities would be OK for my child to do?
• Is there a treatment or medication for MASLD?
• What are clinical trials, and are there any clinical trials for children who have MASLD?
• Will losing weight help to get rid of this disease?
• Is my child’s steatotic (fatty) liver disease advanced? If so, do we need to consider transplant?

*Metabolic dysfunction-associated steatotic liver disease (MASLD) is the new name for nonalcoholic fatty liver disease (NAFLD).

*Metabolic dysfunction-associated steatohepatitis (MASH) is the new name for nonalcoholic steatohepatitis (NASH).

Last updated on August 20th, 2025 at 09:38 am