MASLD (metabolic dysfunction-associated steatotic liver disease), commonly known as ‘fatty liver,’ occurs when excess fat builds up in the liver. Once rare in children, it is now one of the most common liver conditions affecting young people. On Global Fatty Liver Day, Dr Eirini Kyrana, a paediatric liver specialist at King’s College London, shares her insights on this concerning trend.
MASLD is associated with overweight and obesity and cases are rapidly increasing in the UK. Specialised clinics are based at the country’s three paediatric hepatology units, King’s College Hospital, Birmingham Children’s Hospital and Leeds Children’s Hospital, as well as some paediatric gastroenterology centres. At King’s alone, we see roughly 200 new cases annually, with patients ranging from six to 18 years old.
Patients may have MASLD in isolation or be accompanied by other health problems like insulin resistance, type 2 diabetes, hormonal imbalances like polycystic ovary syndrome, sleep troubles, mental health concerns, and mobility limitations.
Most children reach us after their paediatrician orders an ultrasound showing a ‘fatty’ liver, sometimes with abnormal liver function tests. Our first step is to rule out other causes of liver fat accumulation. We then determine whether inflammation or scarring has developed using blood tests and specialized scans like the FibroScan.
Not every child with a ‘fatty’ liver has liver disease. Some have “simple steatosis”—fat deposits in the liver without inflammation or scarring to the liver. Regardless, all children need appropriate assessment and tailored follow-up care.
The encouraging news is that, unlike other childhood liver diseases, ‘fatty’ liver disease in young people can be reversible. Because of the young age of the patients, even children with inflammation or early scarring can see remarkable improvement with weight loss. We have witnessed many young patients completely turn their health around.
Unfortunately, MASLD carries unfair stigma that other childhood liver conditions do not carry. This reflects broader societal challenges requiring action across government policy, public health initiatives, food industry regulation, education, and healthcare.
For worried parents, I would advise to ask your GP for a paediatric referral. Early diagnosis and monitoring lead to better outcomes. Rising childhood MASLD is not inevitable—we can and must do better.
For more information, visit the Children’s Liver Disease Foundation’s resources on fatty liver disease here
