Pediatric Fatty Liver Disease

What is Pediatric Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)?

MASLD (metabolic dysfunction-associated steatotic liver disease)* is a spectrum of diseases that all begin with excess fat deposition in the liver. As the disease becomes more severe, inflammation or irritation of the liver occurs and then scar tissue (fibrosis) accumulates. The disease is then referred to as MASH (metabolic dysfunction-associated steatohepatitis.*). If the fibrosis is extensive, cirrhosis develops and the liver may function poorly.

How common is Pediatric MASLD?

MASLD is the most common liver disease in the United States. It is thought to affect approximately 30 million people, 8.6 million of whom have the more severe form of the disease, NASH. MASLD affects almost 10% of all children in the United States. Approximately 1% of 2 to 4 year olds, and 17% of 15-19 year olds have MASLD. In addition, 38% of obese children have MASLD. Among adults, MASLD has become the 3rd leading indication for liver transplant. Children, who will have the longest time course of disease, are at particular risk of complications and poor prognosis, including the need for liver transplant in adulthood.

What are the risk factors for developing pediatric MASLD?

Most children with MASLD are in their early adolescent years. MASLD, however, is being increasingly observed in young children. Males are affected twice as often as females and Hispanics are more likely to develop MASLD than non-Hispanics whites or blacks. Obese children are at the greatest risk for developing MASLD. In addition, having type 2 diabetes or prediabetes, the metabolic syndrome, or hyperlipidemia (high cholesterol) increases your risk of developing MASLD.

What are the symptoms of pediatric MASLD and how will my doctor diagnose it?

Most commonly, children with NAFLD do not have symptoms. In such an instance, a doctor may notice abnormal blood tests during a routine well child check up. Some children experience right sided abdominal pain, fatigue, or constipation. On exam, doctors may find obesity, especially in the waist area, an enlarged liver, signs of insulin resistance called acanthosis nigricans, a dark discoloration on the back of the neck and armpits, or the exam may be completely normal.

In order to diagnose pediatric MASLD, your doctor will start with blood tests to look for elevations of liver enzymes. They may also test for prediabetes and hyperlipidemia, and try to exclude other causes of liver disease, such as viral hepatitis, autoimmune hepatitis and Wilson’s disease. They may check an abdominal ultrasound to look for fat deposition in the liver. The only way to be certain that your child has MASLD, however, is a liver biopsy. This test allows the doctor to diagnose MASLD, and how severe the disease is.

What causes MASLD?

The exact cause(s) of pediatric MASLD is currently unknown. It is likely a combination of several factors, including a predisposing genetic background along with environmental triggers that allow for insulin resistance and accumulation of specific fats in the liver. Activation of immune cells and oxidative stress then likely can cause ongoing damage to the liver.

What can I do if my child has MASLD?

Currently there is no medication that treats this disease. Many research trials of medications for MASLD are underway and may yield effective medications in the future. MASLD must be treated by gradual weight loss, typically about one pound per week. Research shows that for many children, losing only 10% of their body weight can help their liver disease. This should occur through a combination of both exercise and dietary changes. A reasonable goal is to exercise three to five times per week for at least 30 minutes. Exercise not only helps to burn stored calories, but also increases the body’s metabolism. Nutrition should be balanced, including regularly eating breakfast. Sugar sweetened beverages should be limited and lean meats, poultry and fish, along with fresh fruits and vegetables and whole grains emphasized.

Shikha S. Sundaram, MD MSCI is the Assistant Professor of Pediatrics at the University of Colorado School of Medicine and Children’s Hospital Colorado. She is interested in childhood liver disease, metabolic dysfunction-associated steatotic liver disease and pediatric liver transplant. She wrote this month’s article on pediatric metabolic dysfunction-associated steatotic liver disease.

*Steatotic liver disease is the new name for fatty liver disease.

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

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

Medically reviewed on April 2025.

Last updated on June 12th, 2025 at 01:37 pm