Nonalcoholic fatty liver disease (NAFLD), or excess fat in the liver, is the most common liver disease in children in the United States. Some children have a more severe type of NAFLD, called nonalcoholic steatohepatitis (NASH). In children with NASH, the liver not only has excess fat but is also inflamed. NASH patients have a high risk of scar tissue developing in their livers, which raises their risk of cirrhosis (severe scarring of the liver) and even liver cancer (hepatocellular carcinoma) as they grow older.

At the University of Chicago Medicine Comer Children’s Hospital, we focus on reversing — and when possible, avoiding — potentially severe health risks in children with fatty liver disease.

Obesity, Weight Loss and Weight Management in Children with Fatty Liver Disease

Children with NAFLD or NASH are commonly overweight or obese. Obesity significantly raises your child’s risk for NAFLD, as well as type 2 diabetes, high blood pressure and other serious health conditions.

Right now, weight loss is typically the most effective way to prevent and treat most cases of NAFLD and NASH. If your child is still growing, we may focus on maintaining a healthy weight as your child grows taller.

Our goal is to help, not judge.

Every year, our specialists counsel and help hundreds of children who have NAFLD or NASH, or who are at risk for developing these conditions. At Comer Children’s, this has given our team a first-hand understanding of how difficult it can be for children to change their eating habits and increase their physical activity. It often requires your entire family to make changes. In addition to monitoring your child’s liver health, we will help you identify specific approaches for encouraging healthy eating and physical activity that work for your child and your entire family.

Our Pediatric Fatty Liver Disease Care Team

At Comer Children’s, our team of pediatric specialists provides comprehensive care and behavioral support for each child and family.

Your child’s care team will include:

  • Pediatric hepatologist Ruba Azzam, MD, MPH, who specializes in diagnosing and medically managing NAFLD and NASH, as well as a wide variety of liver diseases and liver failure in children
  • Pediatric nutritionists, who can help you and your child design an eating plan that is healthy and not overly restrictive
  • Pediatric social workers, who can connect you and your child to a variety of health maintenance resources
  • Physical therapists, who will work with you and your child to choose a wide variety of appropriate exercise regimens

In addition, Comer Children’s offers comprehensive medical and surgical care for children with a range of complex health concerns. If your child has or develops type 2 diabetes, high blood pressure or other complications related to NAFLD or NASH, we can refer you to an experienced doctor who specializes in the type of care your child needs.

Frequently Asked Questions

Liver disease is called a “silent” condition because it does not typically cause symptoms in the early stages. Children with NAFLD don’t typically have symptoms, although about 40% may complain of abdominal pain (specifically, on the upper right side of the belly).

Being obese or overweight raises the risk of NAFLD. So does having certain conditions that often develop when you are overweight or obese, including type 2 diabetes, high lipid levels in blood and high blood pressure.

In addition, older children who have reached puberty are more likely to develop these two conditions than younger children, and boys have higher risk than girls. A family history of NAFLD or NASH may also raise a child’s risk.

Racial/ethnic variations also exist. Hispanic children have a greater risk of NAFLD compared to white children. Black non-Hispanic children are less susceptible to NAFLD but have a higher risk for developing diabetes.

Environmental factors, including the consumption of sugar-sweetened beverages, has been linked to the increased prevalence of obesity and NAFLD. A sugar-rich diet increases the production of triglycerides in the liver.

The reason why some children develop NASH versus NAFLD continues to be heavily researched. NASH is more likely in children with type 2 diabetes or insulin resistance. Some research suggests genetic causes as well.

When your child is at risk for NAFLD due to obesity or other reasons, pediatricians will typically order blood tests. The doctor will look for increased levels of certain liver enzymes, namely alanine aminotransferase (ALT) and aspartate aminotransferase (AST).

If liver enzymes are elevated, an imaging test might be ordered so doctors can see whether the liver shows any signs of disease.

However, conducting a liver biopsy is currently the only way to definitively diagnose NAFLD and NASH. This is an outpatient procedure that involves obtaining a very small sample of your child’s liver to look at under the microscope.

Typically, we recommend a liver biopsy when the liver enzymes continue to be abnormal and/or when we need to rule out other liver diseases

Weight loss is typically achieved by:

  • Helping your child substitute unhealthy, high-calorie foods and drinks with lower-calorie, nutritious foods
  • Encouraging your child to be more physically active

Parents, caregivers and other family members can help by modeling these healthy behaviors. Weight loss and behavior change can be challenging — at any age. That’s why our team is here. We’ll help your child and your entire family identify strategies that work for you.

Currently, no medications are used to directly treat NAFLD in children.

However, we may consider weight loss medications for some children if they are having trouble losing weight naturally or have a high risk of developing serious health problems.

Some obese children may be candidates for weight loss surgery or endoscopic procedures. We can talk to you and your child/adolescent about those options and refer your child to our Pediatric Bariatric Surgery team.  Comer Children’s is part of UChicago Medicine, which has been a leader in weight loss surgeries for decades. The weight loss team at UChicago Medicine is the most experienced in the Chicago area and has helped teenagers as well as adults.
Ruba K. Azzam, MD

Ruba Azzam, MD, MPH

Ruba Azzam, MD, MPH, specializes in pediatric hepatology, gastroenterology and nutrition, including hepatobiliary diseases, liver transplantation, pancreatic disorders and more.

Learn more about Dr. Azzam