Pediatric Fatty Liver Clinic
Fatty liver disease – now referred to as metabolic dysfunction-associated steatotic liver disease, or MASLD – is a widespread liver problem that affects many children and teens. It often occurs alongside obesity and metabolic issues. Here at the Kentucky Children's Hospital Pediatric Fatty Liver Clinic, we have a team of specialists dedicated to improving your child's liver health and helping your child manage their weight.
Providing early treatment for children who have excess fat in the liver can make a big difference in their liver health and prevent future liver-related problems. Currently, steatotic liver disease (SLD) is one of the most common reasons for liver transplants in adult patients. It is also the fastest-growing cause of liver transplants in young adults ages 18 to 25.
Since the disease may not show symptoms at the start, it is important to have a screening so that it can be caught early. Ours is the only program of its kind in Kentucky that focuses on helping children with this condition. Together, we can take proactive steps to tackle the disease and promote your child's well-being.
What is MASLD?
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a buildup of too much fat in the liver. Over time, this buildup can cause liver scarring (fibrosis) and, eventually, cirrhosis or liver failure. The previous name for MASLD was non-alcoholic fatty liver disease (NAFLD).
MASLD can develop at any age, but it often begins in childhood. The good news is that by losing just five percent of their body weight, children can reverse fat buildup in the liver. And by shedding 10 percent of their weight, they may see an improvement in liver scarring (fibrosis).
Risk factors for MASLD
Researchers don’t know exactly what causes metabolic dysfunction-associated steatotic liver disease, but risk factors include:
- Obesity
- Insulin resistance or diabetes
- Environmental factors, such as lack of access to fresh, healthy foods
- Excessive intake of sugar and fast food
- Not enough physical activity (excessive screen time)
- Sleep apnea
- Family history of non-alcoholic fatty liver disease
- Genetic predispositions (ie. PNPLA3, TM6SF2, MBOAT7, GCKR, HSD17B13)
- Hispanic ethnicity
Children with obesity and insulin resistance are more likely to develop liver scarring and liver dysfunction.
Our team approach
Your child’s treatment team will include experts in liver disease, nutrition and obesity. This includes:
- A board-certified pediatric gastroenterologist who focuses on treating children with MASLD
- A pediatrician board-certified by the American Board of Obesity Medicine to diagnose and treat children with excessive weight gain
- A dietitian who provides evaluation and nutritional counseling for children
- A nurse coordinator who works with you to schedule your child’s appointments, including tests and further workups
If your child needs to see other specialists to address issues related to weight, we can help. Our clinic works closely with specialists in endocrinology, genetics, neurology, nephrology, radiology and sleep medicine.
Diagnosing MASLD
First, we look for causes for your child’s liver disease, such as:
- Autoimmune issues
- Viral infections of the liver
- Abnormal iron or copper storage
- Common genetic causes of liver disease
- Thyroid issues
We then perform ultrasound-based imaging (FibroScan) to measure fat buildup and look for scarring of the liver. FibroScan is simple and painless. It involves placing a probe on your child's skin and tapping on (sending sound waves to) their liver.
If your child is at risk for liver scarring, we use magnetic resonance imaging (MRI) to further assess this risk. This test doesn’t use radiation and can pick up even small signs of liver scarring.
When both imaging tests suggest liver scarring is present, we may perform a liver biopsy. During a biopsy, your child will be completely asleep. We’ll insert a small needle into your child’s liver to remove a tiny tissue sample for testing.
MASLD treatment
Weight loss is the best way to treat MASLD. Involving the whole family is the key to success. We’ll provide nutrition and exercise counseling. This will help you support your child as they work to manage their weight.
We’ll check in with you and your child regularly. You’ll be able to ask questions and get support. We typically suggest these steps to help your child:
- Reduce and cut out sugary drinks (soft drinks, fruit juice and smoothies)
- Choose healthy foods
- Eat breakfast regularly and limit eating in the evening
- Move and exercise daily to help with weight loss
- Take a vitamin E supplement
If your child has liver scarring, we may suggest medicines to help with weight loss and reverse scarring. There are FDA-approved medicines to help patients 12 or older lose weight. Some teens 16 and over who struggle to lose weight may be eligible for bariatric weight-loss surgery.
