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Pediatric Non-alcoholic Fatty Liver Disease (NAFLD)

Published on Jun 27, 2022 and last reviewed on Jun 28, 2022   -  5 min read


Non-alcoholic fatty liver disease in children is a condition in which fat accumulates in the liver. Keep reading to know more about the condition.


What Is Non-Alcoholic Fatty Liver Disease?

Non-alcoholic fatty liver disease (NAFLD) is when excess fat accumulates in the liver. It is the most common cause of liver disease in children in the United States. Though a mild condition with less visible symptoms, it can progress to a more severe form of liver disease that causes scarring of the liver tissue (cirrhosis) or liver cancer in adulthood if left untreated. The more severe form of the disease is called non-alcoholic steatohepatitis (NASH).

How Common Is NAFLD in Children?

NAFLD is the most common form of liver disease affecting about ten percent of children in the United States.It is the second most common cause of liver transplantation in the pediatric population. It has affected about 30 million children, of whom around 8.6 million have a more severe form of the disease, NASH.

Who Is at an Increased Risk of Developing NAFLD?

Risk factors for developing NAFLD include the following:

What Are the Causes of Non-Alcoholic Fatty Liver Disease (NAFLD)?

The exact cause of NAFLD is not known. Genetic factors also influence NAFLD, one gene, in particular, is the PNPLA3. However, researchers have reported that the following conditions can be the probable cause of NAFLD:

Initially, steatosis progresses to steatohepatitis to fibrosis and finally to cirrhosis.

What Are the Risk Factors for Non-Alcoholic Fatty Liver Disease (NAFLD)?

The following are the risk factors for developing NAFLD:

  1. High cholesterol.

  2. High triglyceride levels.

  3. Sleep apnea (a condition in which there is an interruption to breathing during sleep).

  4. Metabolic disorders are a group of disorders that lead to increased heart problems and related issues.

What Are the Symptoms of Pediatric Non-Alcoholic Fatty Liver Disease (NAFLD)?

In most cases, NAFLD does not present any visible symptoms. On examination, the doctors may notice an enlargement of the liver or obesity, more predominantly in the waist area. Acanthosis nigricans, a condition in which there is discoloration of the neck and armpits, indicating insulin resistance, is also a symptom of NAFLD.

Routine check-ups of the child may show abnormal blood test readings. In some cases, the child may show symptoms like pain in the abdomen, tiredness, constipation, weakness, and weight loss.

What Are the Complications of Pediatric Non-Alcoholic Fatty Liver Disease (NAFLD)?

NAFLD being a chronic condition, requires regular medical care for the child’s entire life. The liver tissue begins to scar when NAFLD progresses to NASH (non-alcoholic steatohepatitis). The soft and healthy liver tissue gets scarred, causing cirrhosis which prevents the liver from functioning properly. If left untreated, cirrhosis can lead to complications like portal hypertension (a serious complication in which there is pressure build-up in the blood vessels supplying the liver), liver failure, or cancer of the liver. These complications may require liver transplantation. Though serious, the complications can be prevented if the fat build-up in the liver cells can be slowed down or stopped. Extrahepatic manifestationslike cardiovascular disease, low bone mineral density, and type II diabetes can also be presented.

How Is Pediatric Non-Alcoholic Fatty Liver Disease (NAFLD) Diagnosed?

The doctor diagnoses NAFLD based on a combination of medical history, physical examination, signs and symptoms, and blood tests. The following tests may be ordered by the health care worker to confirm the diagnosis:

Children diagnosed with NAFLD require periodic monitoring to check the levels of the following:

A check for prediabetes and high cholesterol levels is done. The doctors may also order tests to rule out other liver disorders like:

How Is Pediatric Non-Alcoholic Fatty Liver Disease (NAFLD) Treated?


Pediatric non-alcoholic fatty liver disease is the most common form of liver disease in children in the United States. The most common reason is obesity. Early identification and necessary lifestyle changes, as suggested by the doctor, help prevent the condition from proceeding into a more severe form that may cause complications or a need for a liver transplant. Mindful eating, regular exercise, and an active lifestyle, along with keeping a check on weight gain, can give a positive outlook on the condition.


Frequently Asked Questions


What Is Pediatric Nonalcoholic Fatty Liver Disease?

Pediatric nonalcoholic fatty liver disease (NAFLD) is characterized by excess fat accumulation in the liver, which does not occur due to alcohol consumption. The liver is not inflamed or damaged in pediatric NAFLD. It is not a life-threatening condition and does not progress to cause complications. The characteristic signs and symptoms include weakness, pain in the upper abdomen, shortness of breath, and jaundice.


Does Non-Alcoholic Fatty Liver Disease Occur in Children?

Non-alcoholic liver disease may occur in children due to several medical conditions. However, it more commonly affects boys of 10 years of age or less. The main factors responsible for causing non-alcoholic liver disease in kids are:

- Lack of physical activity.

- Poor eating habits.

- Therefore excess fat accumulates in the liver, causing non-alcoholic fatty liver disease in children.


Is Nonalcoholic Fatty Liver Life-Threatening?

Non-alcoholic fatty liver disease is not a severe condition. Moreover, it does not cause significant symptoms, but early treatment is essential in preventing severe liver damage. Lifestyle changes and proper diet may prevent one from its complications. However, certain risk factors like obesity, high blood pressure, type 2 diabetes, etc., increase the risk of cirrhosis and liver failure. These conditions are life-threatening and require liver transplantation for survival.


What Causes Fatty Liver in Children?

Fatty liver may occur in children due to the following factors:

- Genetic factors.

- High blood pressure.

- Type 2 diabetes.

- High cholesterol level.

- Malnutrition.

- Celiac disease.

- Certain medications.


What Are the Features of Liver Problems in Children?

The signs and symptoms of liver disease in children are as follows:

Yellowish discoloration of the skin and other mucous membranes.

- Itching.

- Fatigue.

- Poor weight gain.

- Abdominal pain.

- Vomiting.

- Abnormal bleeding.

- Liver enlargement.

- Yellow urine.

- Accumulation of fluid in the abdominal cavity.


Does Cirrhosis Occur in Children?

Liver cirrhosis in children is possible due to various conditions like:

- Hepatitis.

- Genetic disorders.

- Fatty liver disease.

- Bile duct diseases.

- Certain medications like Isoniazid, excess vitamin A supplements, etc.


Is It Possible to Reverse Fatty Liver in Children?

Yes, it is possible to reverse fatty liver in children during the initial stage of the disease by:

- Take measures to reduce weight in children if they are obese. In turn, it helps decrease the inflammation and fibrosis of the liver.

- Avoid sweetened beverages.

- Increase physical activity in children.

- Avoid junk foods.


Is Fatty Liver Normal in Kids?

Several studies show that about one in ten children is affected by fatty liver. It remains to be the main reason for causing chronic liver disease. Fat accumulates in the liver, but damage and inflammation may not occur. If left untreated, the disease may progress to cirrhosis and liver failure in children. The lack of exercise and obesity in the long term leads to fatty liver in children. However, the disease is reversible with improved physical activity and a proper diet.


At What Age Does Fatty Liver Occur?

In the pediatric population, the non-alcoholic fatty liver more commonly occurs at 10 to 13 years of age. Boys are more commonly affected than girls. The risk factors for fatty liver include obesity, type 2 diabetes, and high cholesterol. Fatty liver may also occur in children 2 to 18 years of age, mainly due to type 2 diabetes. Therefore, it is essential to maintain a healthy weight through a nutritious diet and physical activities.

Last reviewed at:
28 Jun 2022  -  5 min read




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