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Nonalcoholic Fatty Liver Disease

Healthy vs Fatty Liver

Nonalcoholic fatty liver disease (NAFLD) is a liver disease that happens slowly over time. It starts when fat builds up inside the liver. Over time, too much fat stays in the liver. Nonalcoholic fatty liver disease can be mild or severe.

  • In mild cases, children only have fat build-up.
  • In severe cases—also called non-alcoholic steatohepatitis or NASH—fat is combined with liver damage (inflammation or irritation) which can cause scar tissue. The scar tissue is called "fibrosis." As fibrosis builds up, it may lead to cirrhosis. Cirrhosis happens when the liver is scarred and no longer works properly.

What causes nonalcoholic fatty liver disease (NAFLD)?

Nonalcoholic fatty liver disease usually happens in children and teenagers who are overweight or gain too much weight. Most of the time, fatty liver happens with other health problems, such as:

  • Pre-diabetes, insulin resistance or diabetes
  • High triglycerides
    • Triglycerides are a type of fat found in your blood. They are used for energy.
  • Being overweight

What are the symptoms?

The symptoms of nonalcoholic fatty liver disease will vary depending on the stage of your child’s disease. Some symptoms may include:

  • Fatigue
  • Fluid in the belly or legs
  • Increased liver enzyme levels in your child’s blood
  • Abdominal pain

Can nonalcoholic fatty liver disease cause health problems?

Nonalcoholic fatty liver disease can damage the liver, so it is important your child be carefully diagnosed and treated. NAFLD:

  • Increases the chances of heart attacks and strokes
  • Could lead to liver failure with cirrhosis, which may require a liver transplant in some cases

How is nonalcoholic fatty liver disease diagnosed?

Early diagnosis is very important for children with nonalcoholic fatty liver disease. To determine if you child has nonalcoholic fatty liver disease and the extent of liver damage, the following tests may be performed:

  • Blood tests (liver enzymes): to see if there is liver damage and to rule out other causes of your child's liver problems
    • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both commonly called liver enzymes. When there is damage or inflammation in the liver, these numbers usually go up.
    • AST and ALT are not specific to one disease and can be high from many different types of liver problems. More testing is usually needed to figure out what caused the elevation in the liver enzymes.
  • Liver ultrasound or MRI: to look for fat or other abnormalities in the liver 
  • Liver biopsy: may be used for diagnosis 

How is nonalcoholic fatty liver disease treated?

Childrens with nonalcohoic fatty liver disease benefit most from stopping their weight gain. We encourage children and their families to follow key healthy behaviors:

  • Avoid sugar drinks
  • Drink mostly water and some low fat milk
  • Get at least 60 minutes of physical activity every day
  • Limit TV and screen time to one hour of less per day
  • Make half your plate vegetables at mealtimes
  • Eat breakfast everyday

Other things that can harm the liver should be avoided, like drinking alcoholic beverages.

Some treatments are available. And there are ongoing research studies focused on finding medicines to treat nonalcoholic fatty liver disease. Your child's doctor may start a medicine after discussing the risks and benefits.

How can I help my child?

Work together as a family to improve your healthy habits. Small changes can make a big difference over time.
  • Start with one new healthy habit today.
  • Continue to add healthy changes over the coming weeks and months.
  • Work with your child's doctor to get any tests that are needed.
  • Follow treatment recommendations.

Nonalcoholic fatty liver disease can get better with medical care, healthy habits and sometimes medications. Learn about Children's NAFLD clinic and current research taking place.


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