MASLD
Metabolic dysfunction-Associated Steatotic Liver is a type of fatty liver disease, which is characterized by accumulation of fat in the liver in the absence of other competing disorders of liver and no alcohol consumption. Even kids do have fatty liver just as adults, but the area in the medical field remains under-studied, under-recognized and, possibly undermanaged.
There are cases of MASLD in kids as young as 2 years and MASH associated liver complications like cirrhosis in patients as young as 8 years of age. But in general most of the cases are diagnosed when the child is above 10 years old and the average age of diagnosis is 11 to 13 years of age. MASLD in most cases is diagnosed when the MASLD associated co-morbidities like insulin resistance and Type 2 diabetes are being investigated in kids.
Increasing obesity rates in children as young as 3 years of age has led to increasing prevalence of MASLD in kids. It is difficult to ascertain a certain figure for prevalence of MASLD in kids because of scarcity of data and under-recognition of the disease in the medical fraternity.
Your kid may be at the risk of MASLD and MASH if he/she has any of the following
Excess calorie intake and sedentary life style – Excess calorie intake with little or no physical activity in day to life will put your child at increased risk of MASLD(Metabolic dysfunction-Associated Steatotic Liver Disease).
Overweight/obese – Obesity is closely associated with MASLD and MASLD shares commonness with metabolic disorders like insulin resistance, type 2 diabetes, high fat levels in blood and high blood pressure. In children below 3 years of age obesity usually do not progress to conditions like MASLD or MASH but may suggest an underlying hormonal dysfunction.
Sleep apnea – Sleep apnea is a condition where the sleep is interrupted several times due to obstruction of airway.
Insulin Resistance – Insulin resistance is a condition closely associated with obesity, where the cells become insensitive to the insulin hormone resulting in disturbance in glucose metabolism. The condition can be identified with signs like darkened skin at the back of neck, and folds of joints and skin in obese kids. The condition is called Acanthosis nigricans and has been reported in 33%–50% of kids with MASLD.
Genetically prone – If any member of the family like parents or siblings has a history of MASLD or MASH then there are high chances that the kid may have MASLD
Hormonal Disorders – Hormonal disorders like thyroid under functioning or polycystic ovarian disease may also put your child at the risk of MASLD.
Just as in adults, MASLD and MASH in kids do not show any symptoms. Often it is diagnosed accidently during physical examination or routine blood testing.
Few kids may report non-specific symptoms like
On clinical examination there may be sensitivity in upper right abdomen region but practically it is difficult for the doctor to check the sensitivity due to excess fat in the tummy region of the kids. Kids show symptoms only when there is significant damage to the liver.
MASLD is diagnosed by
You should suspect MASLD and consult a physician, if your kid is above 10 years of age and has any of the following
It should be noted that in adults simple fatty liver/MASLD might not pose a risk of cirrhosis and liver failure, but in kids
Both MASLD and MASH are managed by lifestyle modifications with an aim to reduce weight
Calorie restriction with elimination of sugar-sweetened beverages and food products, fast foods and high-fat content foods like fried foods, as well as minimizing portion sizes, should all be done with expert advice. It is to be noted that currently there is no specific recommended diet for MASLD.
Habituate physical activities to encourage the child to play outdoors, ensuring they get adequate exercise every day.
It is important to identify children with risk factors for MASLD as early as possible and provide interventions to manage, reverse, and prevent MASLD from progressing into more complex forms that manifest with various serious complications.
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