Symptoms & Causes of NAFLD & NASH in Children

What are the symptoms of NAFLD and NASH in children?

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are typically silent diseases with few or no symptoms. Children may not have symptoms even if they develop cirrhosis due to NASH. Once symptoms arise, however, a child may already have permanent liver damage. If children do have symptoms from NASH, they may feel tired, become tired easily, or have discomfort over the liver, in the upper right side of the abdomen.

What causes NAFLD and NASH in children?

Experts are still studying the causes of NAFLD and NASH. Research suggests that certain genes may make some children more likely to develop NAFLD.

Children with the following health conditions are also more likely to develop NAFLD or NASH:

  • overweight or obesity
  • insulin resistance or type 2 diabetes
  • high blood pressure
  • abnormal levels of fats in the blood, which may include
  • metabolic syndrome, or one or more traits of metabolic syndrome. Metabolic syndrome is a group of traits and medical conditions linked to overweight and obesity. People with metabolic syndrome are more likely to develop type 2 diabetes and heart disease. Experts think NAFLD may be closely linked to metabolic syndrome. Doctors typically define metabolic syndrome in children as a combination of three or more of the following features:
    • large waist size
    • high levels of triglycerides in the blood
    • low levels of HDL cholesterol in the blood
    • high blood pressure
    • higher-than-normal blood glucose levels
    Doctors may not be able to diagnose metabolic syndrome in children younger than age 10. Children in this age group may still have traits of metabolic syndrome.

Experts do not know for sure why some children with NAFLD have simple fatty liver while others have NASH. Research suggests that NASH is more common in children who have both NAFLD and type 2 diabetes.3

Certain genes may also increase a child’s chance of developing NASH. These genes may explain why NASH is more common in Hispanic and Asian American children than in black or African American children. Experts are still studying how the genes act to cause NAFLD and NASH.

Less common causes of NAFLD and NASH in children

Less common causes of NAFLD and NASH in children include


Last Reviewed November 2017

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
Jeffrey B. Schwimmer, M.D., University of California, San Diego, School of Medicine