Dr. Neelam Mohan: Fatty Liver Epidemic Among Kids A Wake-Up Call For Parents

A silent health crisis is taking root among adolescents and even young children—Metabolic dysfunction-associated Steatotic Liver Disease (MASLD). Formerly known as Non-Alcoholic Fatty Liver Disease (NAFLD), this liver condition is fuelled by sedentary lifestyles, unhealthy diets, and declining physical activity. Early detection and treatment is a need of the hour, Dr. Neelam Mohan tells The Outlook Health.

What is MASLD, and why has it suddenly become a cause for concern?

MASLD is now recognized as the most common chronic liver disease globally. It is caused by the accumulation of fat in the liver in individuals without significant alcohol intake and is strongly associated with obesity, poor dietary habits, and physical inactivity. Left unchecked, MASLD can progress to liver inflammation (known as MASH), scarring (fibrosis), cirrhosis, and even liver cancer.

With the rise of sedentary lifestyles, high-calorie diets, excessive sugar consumption, and widespread intake of processed foods, MASLD has emerged as a silent yet growing epidemic. While it was once largely confined to middle-aged adults, we now see it increasingly diagnosed in adolescents and even younger children. In India, MASLD is estimated to affect 10–18% of school-going children—and this number rises to 35–45% in obese children.

What makes this especially concerning is that the disease is often silent in its early stages, going undetected until serious damage has occurred.

Is MASLD more common in boys or girls? What explains this difference?

At Medanta – The Medicity, we reviewed data from 150 obese children and adolescents attending our outpatient clinic. Two-thirds of the children were boys, and one-third were girls. Of these, 42% had abnormal liver enzyme levels along with ultrasound or elastography findings consistent with fatty liver. Notably, 49% of the boys showed elevated liver enzymes, compared to 25% of the girls.

Globally, studies also suggest that MASLD is slightly more common in boys. This could be due to differences in fat distribution, hormonal factors, or genetic susceptibility. However, it is important to recognize that girls—particularly those with Polycystic Ovary Syndrome (PCOS) or after the onset of puberty—are also at considerable risk.

What can be done to prevent MASLD in children?

The most effective strategy against MASLD is prevention through early lifestyle intervention. Parents should begin by encouraging exclusive breastfeeding in infancy, promoting outdoor play, ensuring children get 8–10 hours of sleep, and limiting screen time—ideally to no more than one hour a day. Avoiding sugary drinks and packaged snacks, and encouraging a balanced diet rich in fruits, vegetables, and whole grains, is essential.

Regular health check-ups—especially for overweight and obese children—can help with early detection. Lifestyle guidance should come from pediatricians and, when needed, pediatric hepatologists.

Public health measures are also crucial. Policies such as school-based nutrition programs, stricter regulation of food marketing to children, and promotion of physical activity can have long-term benefits. The Indian Academy of Pediatrics (IAP), a national organization of over 50,000 pediatricians, is actively working to spread awareness, promote early screening, and educate families about lifestyle modification to reduce the burden of MASLD.

Why should we act now?

MASLD is the most common liver disease in children today, and it is largely preventable. With increasing urbanization and unhealthy lifestyle shifts, this condition is becoming more common and more dangerous. Early awareness, timely screening, and consistent public education are the need of the hour.

A healthy liver begins with a healthy lifestyle. Let’s protect it—early, consistently, and consciously.

About Dr. Neelam Mohan:

Dr. Neelam Mohan is a Senior Pediatric Gastroenterology, Hepatology & Liver Transplantation Specialist with over 25 years of experience. She is affiliated with Medanta – The Medicity, Gurugram, and holds MBBS, MD (Pediatrics), and DM (Gastroenterology). She is the President Elect 2025 of the Indian Academy of Pediatrics and has served as Advisor to PM-JAY and the National Board of Examinations (NBE) for Pediatrics. She is also the Immediate Past President of the Commonwealth Association of Pediatric Gastroenterology and Nutrition, and the Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition.