Fatty liver disease, now known as metabolic dysfunction-associated steatotic liver disease (MASLD), has long been associated with adults, particularly those living with obesity, type 2 diabetes and other metabolic conditions. However, doctors are increasingly reporting that the condition is also being diagnosed in children, especially those who are overweight or obese, raising concerns about its long-term impact on liver and overall health.

According to the World Health Organisation (WHO), childhood overweight and obesity have risen dramatically over the past few decades, increasing the risk of metabolic disorders, including fatty liver disease. Although many children with MASLD have no symptoms, the condition can silently progress to liver inflammation, fibrosis and, in some cases, advanced liver disease if left unrecognised.

Research from India also suggests that the burden may be substantial among high-risk children. A 2016 study that screened overweight and obese children aged 11–15 years found that 62% had non-alcoholic fatty liver disease (NAFLD). The researchers concluded that “NAFLD is common in asymptomatic overweight and obese Indian children” and recommended screening this high-risk group using alanine transaminase (ALT) testing and ultrasonography.

More recent findings point in a similar direction. A 2025 cross-sectional study involving 230 overweight and obese children aged 5–15 years reported that 44% had NAFLD. The researchers found that higher levels of serum cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C) and alanine aminotransferase (ALT) were independently associated with the disease, highlighting the close link between fatty liver and underlying metabolic abnormalities.

Despite the growing burden, there is currently no approved medication specifically for treating MASLD (formerly NAFLD) in children. Instead, treatment primarily focuses on healthy weight loss, improved nutrition, increased physical activity and management of metabolic risk factors, while researchers continue to investigate potential therapies.

As concerns grow over the rising number of children affected by fatty liver disease, we spoke to Dr Sunil Shivappa Hanasi, Consultant – Neonatology and Pediatrics, Rainbow Children’s Hospital, Bengaluru, to understand why MASLD is becoming more common in children, which warning signs parents should watch for, who is at greatest risk, and whether the condition can be reversed if detected early.

Fatty liver disease in children is becoming increasingly common

Dr Sunil Shivappa Hanasi said that fatty liver disease, now known as metabolic dysfunction-associated steatotic liver disease (MASLD), is emerging as one of the most common chronic liver diseases in children worldwide.

According to Dr Hanasi, the condition develops when excess fat accumulates in the liver of children who consume little or no alcohol. While it was once considered largely an adult disease, rising childhood obesity, unhealthy dietary habits and sedentary lifestyles have led to an increase in paediatric cases.

“One of the biggest concerns is that MASLD is often silent in its early stages. Many children do not have obvious symptoms, making early diagnosis difficult,” he said.

He added that when symptoms do occur, they may include persistent fatigue, unexplained weight gain, or a dull pain or discomfort in the upper right side of the abdomen. In many cases, the disease is detected incidentally after routine blood tests reveal elevated liver enzymes or an ultrasound shows fat accumulation in the liver.

Which children are at greater risk?

According to Dr Hanasi, obesity is the strongest risk factor for MASLD, particularly excess abdominal fat. Other important risk factors include insulin resistance, type 2 diabetes, abnormal cholesterol levels and a family history of metabolic disorders.

“Diets high in sugary beverages, processed foods, refined carbohydrates and unhealthy fats significantly increase the risk. Children who spend long hours on screens and get very little physical activity are also more likely to develop fatty liver disease,” he said.

He noted that the diagnosis is usually based on a combination of medical history, physical examination, blood tests and imaging such as ultrasound or MRI. In selected cases where advanced liver damage is suspected, a liver biopsy may be recommended to assess the degree of inflammation and fibrosis.

Why early diagnosis is important

Dr Hanasi explained that if left untreated, simple fatty liver disease can progress to metabolic dysfunction-associated steatohepatitis (MASH), a more severe form of the disease characterised by liver inflammation and ongoing liver cell injury.

“MASH can eventually lead to fibrosis, cirrhosis and even liver failure later in life. Children with MASLD also face a higher risk of developing type 2 diabetes, cardiovascular disease and other metabolic complications as they grow older,” he said.

He emphasised that recognising the disease early provides the best opportunity to prevent long-term liver damage.

No approved medicines; lifestyle changes remain the cornerstone of treatment

Dr Hanasi said that no medicines have been approved specifically for the treatment of MASLD in children, making lifestyle modification the cornerstone of management.

“Gradual weight loss through a balanced diet and regular physical activity can reduce liver fat and improve liver health. Children should eat more fruits, vegetables, whole grains, lean proteins, nuts and healthy fats, while limiting sugary drinks, fast food, processed snacks and excess sugar,” he said.

He added that “children should aim for at least 60 minutes of moderate-to-vigorous physical activity every day, while parents and caregivers play a crucial role in creating healthy eating habits, reducing screen time and encouraging outdoor activities.”

“When MASLD is detected early and healthy lifestyle changes are maintained, the condition is often reversible, particularly in its early stages. Preventing childhood obesity and promoting healthy habits at home are essential for protecting children’s long-term liver and overall health,” he said.

Also read: Why India now ranks among the world’s top 3 for fatty liver disease | Explained