Nonalcoholic Fatty Liver Disease (NAFLD) in Children

Nonalcoholic fatty liver disease (NAFLD), now called metabolic dysfunction-associated steatotic liver disease (MASLD), is the most common form of chronic liver disease among children and adolescents. NAFLD 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.

NAFLD is a group on conditions that occur in different stages:

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

Childhood Risks of Developing NAFLD

Children may be at a higher risk for NAFLD (now called 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 NAFLD.

Some conditions can look like NAFLD. They need to be ruled out through additional medical tests. These conditions may include:

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

What are the signs and symptoms?

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

If cirrhosis develops, the following symptoms may be present:

  • Jaundice (yellowing of the skin and whites of the eyes)
  • Itchy skin
  • Swelling of the lower stomach
  • Bruising easily
  • Dark urine

How is NAFLD diagnosed?

There is no specific test for NAFLD (now called MASLD). Most children are diagnosed because they are being tested for something else through routine blood tests and ultrasound scans. In some 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 liver disease can have very few symptoms.

Can NAFLD be prevented?

It is not always possible to prevent NAFLD (now known as MASLD) since it can have genetic and environmental factors. It is possible, however, to lower your child’s chances of developing NAFLD through healthy eating, making sure they participate in some form of physical activity, and controlling other existing medical conditions.

How is NAFLD treated?

There are currently no approved medications to treat NAFLD (now called MASLD), 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.

Fatty 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

Questions to Ask Your Doctor

  • What condition does my child have that suggests NAFLD (now called MASLD)?
  • Can NAFLD 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 NAFLD?
  • What are clinical trials, and are there any clinical trials for children who have NAFLD?
  • Will losing weight help to get rid of this disease?
  • Is my child’s fatty liver disease advanced? If so, do we need to consider transplant?

Last updated on February 1st, 2024 at 02:19 pm

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