Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) was formally known as Non-Alcoholic Fatty Liver Disease (NAFLD). The nomenclature was changed in 2023 after extensive review among multiple groups within Hepatology. The terms “non-alcoholic” and “fatty” are stigmatizing and truly did not accurately represent the patient population. There has been more literature and research supporting the metabolic components of liver disease.

Steatohepatitis is an advanced stage of metabolic dysfunction-associated steatotic liver disease (MASLD). If you have a steatotic (fatty) liver disease, your body has accumulated excess fat in the liver. This does not necessarily always cause a problem, but when it does, patients can develop inflammation. Hepatitis simply means inflammation of the liver.

Causes of Steatotic Liver Disease

The exact causes of steatotic liver disease are not known, but risk factors include:

• Being overweight
• Metabolic Syndrome
• Diabetes and insulin resistance
• High levels of triglycerides in the blood (fat in the blood)
• Underactive thyroid
• Underactive pituitary gland
• Race and ethnicity (people with European, Hispanic and Native American ancestry are at greater risk)
• PCOS

Signs and Symptoms of Steatotic Liver Disease

• An ache/pain in the right upper part of the belly
• Weakness/fatigue
• Loss of appetite
• Increased levels of liver enzymes in the blood

More advanced stages may begin to resemble symptoms of cirrhosis. Some of these symptoms include:

• Yellowing of skin and the whites of eyes (jaundice)
• Easy bruising or bleeding
• Belly becomes swollen with fluid (ascites)
• Persistent itchiness (pruitis)

Because children who have steatotic liver disease (MASLD and/or MASH) may not have any symptoms, your child's doctor will check their liver enzyme levels by taking a sample of blood. Normal liver enzyme levels vary with a child's age.

Causes of High Liver Enzymes

• MASH – Metabolic Dysfunction-Associated Steatohepatitis
• Viral infections
• Certain medicines
• Physical activity
• Muscle injury
• Gall stones

Your child's liver doctor may recommend further testing if your child's liver enzymes are very high.

Diagnosis of MASH

The only wa to determine if your child has MASH is to perform a liver biopsy. This is the gold standard test and can help determine the extent of your child’s condition. A liver biopsy is a special test that places a needle through the skin to get a small piece of tissue from the liver. Your child’s doctor will look at this tissue to see if there is any scarring.

Additional testing, prior to liver biopsy, may include:

• Blood Tests (Liver function test, Lipid panel and possibly other labs that can rule out hepatitis oo liver inflammation])
• Imaging tests
• Abdominal ltrasound
• CT scan or Magnetic Resonance Elastography (MRE)
• Liver Stiffness Test (fibroscan)

Treatment for MASLD or MASH

Right now, the only way to treat MASLD and MASH is to have the child lose weight through healthy eating, managing blood sugar, eating a well-balanced diet, and increasing physical activity. Usually the liver disease is reversible if it is in the early stages and no scarring is found. Some medicines, such as Vitamin E, have been shown in studies to improve severe steatotic liver disease or MASH in some adults and children. It is not yet clear why these medicines don’t work for everyone, but genes and other risk factors may play a role. These medicines should be used only for children under the care of a liver doctor, where the response to the medicine can be closely followed.

Tips

• Encourage your child to follow a healthy portion-controlled diet, with low amounts of saturated fats and refined sugars.
• Avoid large portion sizes and sweetened drinks, like soda. Limit the amount of meals eaten at fast food restaurants, since this food is usually high in fat.
• We encourage you to visit with the dietitian to learn about healthy diet choices for your child and family.
• Increasing physical activity and outdoor play is a great way to help children achieve and keep a healthy weight.

A child with MASLD or MASH should have Hepatitis B and A vaccinations to avoid potential injury to the liver caused by these viral infections.

Call Your Child's Doctor If Your Child:

• Becomes jaundiced (skin and/or eyes turn yellow or green in color)
• Complains of increased belly pain or swelling of the belly or legs
• Becomes more short of breath with exercise