We live in exciting times. Charles Dickens described it best in 1859 when he began The Tale of Two Cities with the following well known quote: “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness….” It is exciting to know that scientists have developed chemicals that when given cause a person to ‘not feel hungry’ and helps them lose weight. It is not just one chemical but several new chemicals that are helping the problems of obesity, diabetes, and the multiple health problems associated.
However they don’t work on all patients, they have mild side effects on some patients, and there are different ways that they are taken to be effective with different schedules. It appears that humans have different causes of their problems with obesity and its complications. Could it be that part of the problem with processed food is that some of the chemicals in them cause some humans genes to react by ‘causing cravings’? Exciting times!
We are now identifying early liver disease in children leading to cirrhosis (scarring in the liver). Unfortunately, there is an increase in NonAlcoholic Fatty Liver Disease (NAFLD). This diagnosis can be made in children and adults and its causes are so numerous that it is now called Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). Steatosis is the abnormal retention of fat within a cell or organ. The reason the name was changed (NAFLD to MASLD) was to get rid of the term alcohol or the use of the word “fatty” as these words have nothing to do with this abnormal state.
MASLD occurs when fat deposits in the liver damage the liver cells. This damage causes inflammation which causes scarring which causes cirrhosis and the possibility of needing a liver transplant. It also has associated cardiovascular complications.
MASLD is the leading cause of liver disease in children today. It affects up to 38% of children with obesity in the US. Here’s the scary part…not all children with MASLD have obesity. Another fact is that the occurrence of MASLD has increased 2.7 times since the late 1980’s. Reported in 2019 in the journal, Hepatology, worldwide the prevalence in adolescents was 4.7%.
Diagnosis begins with screening liver enzymes and eliminating all other causes of elevated liver enzyme such as hepatitis. An ultrasound, liver biopsy or MRI can help the pediatric liver specialists determine how much fat is in the liver and how much scarring is present. Workup could also include obesity gene testing as a small number of obese patients have a known genetic cause of their obesity.
There is no medical treatment specifically approved to treat pediatric patients but there are ongoing clinical trials (If funding hasn’t been cut) for possible new chemicals that can help. Lifestyle changes involve healthy diet, increased exercise and weight loss. A gradual weight loss of about 10% body weight can improve liver health in most children.
by Sally Robinson, MD Clinical Professor
Keeping Kids Healthy
Published 9/2025