Nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH)

Nonalcoholic fatty liver disease (NAFLD) is a buildup of too much fat in the liver. This can cause inflammation and swelling of the liver known as steatohepatitis (NASH). It is the most common chronic liver disease in both children and adults in the United States.

About Nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) in children:

People with NAFLD and NASH often have other health problems like overweight and obesity, diabetes (high blood sugar), pre-diabetes, high cholesterol or triglycerides, high blood pressure, polycystic ovaries, or a family member with NAFLD.

What are the symptoms of Nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH)?

Most children with NAFLD/NASH have no symptoms and just have abnormal liver enzymes. Sometimes they can have stomach pain or fatigue.

How is Nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) diagnosed in children?

Routine blood tests and imaging for some other reason often leads to finding NAFLD/NASH. Blood tests show high levels of liver enzymes, high cholesterol or triglycerides, or high blood sugar. A liver ultrasound may be abnormal and show possible fat in the liver. If liver enzymes are high, a liver biopsy may be needed to confirm a diagnosis or to rule out other causes of liver disease.

What is the treatment for Nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH)?

The best treatment for NAFLD/NASH is weight management. This is unique to each person. Some suggestions to lose weight include:

• Eating foods with less sugar and fat
• Eating more fruits and vegetables
• Avoiding sugary drinks like soda and juice
• Increasing physical activity to at least 1 hour per day
• Decreasing screen time to less than 2 hours per day

Children's Wisconsin has a weight management program called NEW Kids which is available to children with health concerns because of overweight or obesity. Bariatric (weight loss) surgery is also available to some adolescents with obesity. Sometimes the doctor will prescribe medications to lower cholesterol or high blood pressure. Vitamin E may be helpful to lower the inflammation in the liver as well. There is research being done for other medications and treatments that me be helpful but have not yet been approved in children.

What is the long-term outlook of Nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH)?

A small number of people who do not get better with treatment develop scarring of the liver (cirrhosis). Some of these people will go on to need a liver transplant because the liver stops working properly, or they get liver cancer. NAFLD/NASH is the second leading cause of liver transplant in adults.