Kansas City,
12:23 PM

Fatty Liver Disease: Causes, Diagnosis & Treatment

Dr. Voytek Slowik, Pediatric Gastroenterology, Transplant Hepatology

As the obesity epidemic continues to get worse in this country, we’re seeing more and more cases of non-alcoholic fatty liver disease (NAFLD) in children, which is the buildup of excess fat in the liver.

What Causes NAFLD

Research shows an average of 34 percent of obese children have NAFLD (in some studies as high as 80 percent). However, just because a child is overweight doesn’t mean the child will develop NAFLD. Obesity is a multifactorial disease, caused by the effects of multiple genes in combination with lifestyle and environmental factors such as food intake, exercise and sleep. So it’s possible someone could be morbidly obese and not have issues with their liver. On the flipside, someone could only be mildly overweight but have liver disease.

Diagnosing NAFLD

NAFLD is a silent disease and there are no symptoms, which is why it’s important for children to have yearly wellness visits with a primary care physician. A blood test can determine if a child has signs NAFLD. Any child considered overweight or obese should have lab work repeated yearly. (A child is considered overweight if the child’s BMI is in the 85th to 95th percentile and obese if the BMI is greater than the 95th percentile.)

Prevention and Treatment

The best way to prevent disease progression is to eat a healthy, well-balanced diet, avoid sugary drinks and sweets, get at least an hour of physical activity daily, and limit screen time as much as possible. The USDA has put together MyPlate – a great resource guide on how find a healthy eating style.

If a child has NAFLD – the good news is its 100 percent reversible if addressed early on. Once a child loses weight and reaches a healthier BMI, the liver will heal, too. The liver is one of the few organs in the body that can regenerate itself.

What Happens When Left Untreated

If left untreated, fat will continue to build up in the liver and get worse as the child transitions to adulthood. Adults can live with the disease for a long time, but eventually, NAFLD can turn into nonalcoholic steatohepatitis, which is the inflammation of the liver. Eventually cirrhosis - severe scarring in the liver - will set in and the disease is no longer reversible. Cirrhosis can lead to liver failure and even death. The only option at this point is a transplant.

Having a Support System

While the cure for NAFLD seems simple, making lifestyle changes to diet and exercise can be difficult for patients and their families and having the right support system can be the key to success.

We see patients several times during the first couple of months to make sure they’re headed in the right direction and staying on track. As part of our multidisciplinary clinic, families meet with Jamie Ryan, PhD, Clinical Psychologist, and Amanda Stasi, LMSW, Masters Social Worker to assess for barriers to making healthy lifestyle changes and identify any psychosocial issues that might impact disease management. Based on the reported treatment barriers, Dr. Ryan and Amanda can help family’s problem solve around these issues, assist in creating sustainable goals for behavior change, and provide support to the patient and family.

After that, patients will check-in with us every six months.

Creating a Healthy Home

Many times the reaction to the diagnosis of this potentially life-threatening disease is disbelief. It can be difficult to comprehend the seriousness of NAFLD since the child may be “just a little overweight” and seem otherwise healthy. Some parents may even struggle with weight management themselves. Unless the entire family addresses lifestyle and dietary changes, kids will have difficulty losing weight.

We worked with our dieticians to develop these helpful tips on how to create a healthy home:

Be a good example

  • Participate in physical activity regularly.
  • Make healthy eating choices and avoid sugary drinks.
  • Limit fast food.
  • Encourage family meals.

Be consistent

  • Set guidelines for meal times and place.
  • Don’t allow eating in bedrooms or in front of the TV.
  • Set screen time limits for the whole family.
  • Spend time with your child.

Be a planner

  • Involve kids in planning and preparing meals and snacks.
  • Plan healthy meals and grocery shop accordingly.
  • Keep a variety of foods like fruit, vegetables and whole grains in the house.
  • Keep quick healthy choices available for meals when you’re rushed.
  • Avoid keeping hard-to-resist foods at home.
  • Plan family outdoor activities such as an after-dinner walk, bike ride or a trip to the park.
  • Try indoor activities like dancing or obstacle courses.

Be patient

  • Remember changing habits take time.
  • Sometimes making one small change at a time is easier than trying to change everything at once
  • Offer a new food more than once.
  • Remember that children have their own likes and dislikes.
  • Make mealtimes relaxing and fun.


Learn more about the Liver Care Center at Children’s Mercy.