Silent Liver Disease Now A Childhood Crisis

When 12-year-old Aarav Sharma from Noida began experiencing fatigue, irritability, and difficulty concentrating in school, his parents attributed it to screen fatigue from long online classes. Slightly overweight and preferring packaged snacks and video games over outdoor play, Aarav didn’t seem seriously ill—just low on energy.

But routine blood tests told a different story. Elevated liver enzymes led to further investigations, and Aarav was diagnosed with early-stage Metabolic dysfunction-associated Steatotic Liver Disease (MASLD), a condition previously known as NAFLD (Non-Alcoholic Fatty Liver Disease). Fatty liver disease is caused by the accumulation of fat in the liver and is estimated to affect one in four people worldwide. If left untreated, it can lead to serious complications, such as cirrhosis and liver cancer, making it crucial to detect early and initiate treatment.

Aarav’s parents were stunned to know that the boy was suffering from NAFLD. His mother Nisha Sharma said, “Aarav just seemed tired, with occasional stomach aches. We never thought it could be something as serious as has been explained by his doctor, a hepatologist.”

The doctor advised immediate lifestyle changes—cutting out sugary drinks, introducing a high-fiber diet, increasing physical activity, and scheduling regular follow-ups. Under a pediatric hepatologist’s care at a Delhi hospital, Aarav’s health gradually turned around.

Today, six months into his new routine, Aarav has not only stabilized medically but also returned to playing outdoors—often cycling in the evenings.

“I used to feel tired all the time, and I hated going outside,” Aarav said. “Now I actually feel like moving. I still miss my chips sometimes, but I like how I feel now.”

Aarav is among the fortunate few diagnosed early, when lifestyle changes can still reverse damage. Across hospitals in India and globally, pediatric hepatologists/ gastroenterologist are raising the alarm: MASLD , a chronic liver disease, affecting roughly 30% of the global population, has become a significant public health concern, driven by rising rates of obesity, diabetes, and aging populations.

Children too are not spared. A one-of its kind US study published in recent journal Hepatology paints this grim reality: children diagnosed with MASLD in the US were over 40 times more likely to die than their healthy peers. Out of 1,096 children studied, 3.4% died—nearly half from liver-related causes, while others died due to cardiovascular issues, accidents, or suicide.

“This shows MASLD may pose a risk beyond other metabolic conditions like obesity or diabetes,” said the first author of the study, Dr. Jeffrey Schwimmer, professor of pediatrics at the University of California, San Diego’s School of Medicine and the director of the Fatty Liver Clinic at Rady Children’s Hospital.

The study “Long-term mortality and extrahepatic outcomes in 1,096 children with MASLD: A retrospective cohort study,” also noted higher mortality risk in boys and children with low levels of “good” cholesterol (HDL).

India mirrors this worrying trend. A 2022 AIIMS study published in the Journal of Clinical and Experimental Hepatology revealed that 38% of Indians have fatty liver disease. Among children, 17% are currently affected, and among obese children, the rate soars to 70–75%, according to Prof Sumit Rungta, head of gastroenterology department at Lucknow-based King George's Medical University (KGMU).

This data was shared during an awareness event organized by kGMU on World Liver Day last year. Dr. Rungta reiterated what has been widely emphasized in the context of most non-communicable diseases (NCDs) — that prevention begins at home. “Preventing fatty liver in children starts at home — with informed parents, nutritious meals, regular exercise and routine check-ups. The earlier we act, the healthier our next generation will be,” he said.

If lifestyle changes could help prevent its progression, delay can be fatally devastating. Dr. Neelam Mohan, senior director and HOD of gastroenterology and liver transplant at Medanta, warned that ignoring the disease can lead to serious complications as was also found in a study conducted under her supervision in the National Capital Region recently.

The results were alarming. At least 150 obese adolescents aged between 10 and 18 years from January last year were examined and it was found that 42% recorded liver enzyme levels at twice the normal range.

Of these adolescents with high enzyme readings, 90% experienced fatty liver and 18% showed fibrosis. Researchers noted the levels reached five times the normal in 14 adolescents who underwent liver biopsy after continuously elevated levels for over three months. They were at risk of developing liver cirrhosis by the age of 30, she said.

"We used to think it takes 2 to 3 decades for liver damage. Now, however, we are observing 10-year-old children developing fibrosis. By the age of 30, they may even develop liver cirrhosis. This is very alarming. The normal is 24 units per litre of serum for boys and 22 units per litre of serum for girls," said Dr. Neelam Mohan.

Only 22% of the 150 adolescents sought obesity treatment. "These findings underscore the urgent need for early diagnosis, lifestyle intervention, and increased awareness of the health risks associated with obesity," she added.

Associate Professor Dr. Anany Gupta, a liver specialist at KGMU, who was associated with AIIMS Delhi till last year too strongly recommended early identification of fatty liver disease through routine screening followed by interventions such as weight reduction, dietary changes and physical activity to reverse fatty liver disease..

He added that fatty liver disease in children is often asymptomatic in the early stages and may go undetected until it leads to complications. Initial symptoms in children can vary, but common signs include jaundice, which causes yellowing of the skin and eyes, as well as abdominal pain or bloating. Affected children may also experience fatigue, loss of appetite, and episodes of nausea and vomiting. Changes in bowel movements, such as dark-colored urine or pale stools, can also be indicators of liver issues.

However, due to lack of awareness and simple diagnostic criteria, the disease remain undiagnosed, leaving the little patients at the receiving end. In severe cases, liver transplant becomes the last resort.

Dr. Shalimar of Delhi-based AIIMS' Gastroenterology Department is of the opinion that since coronary artery disease is the leading cause of death in NAFLD patients without cirrhosis, while liver-related deaths dominate in those with cirrhosis, managing associated comorbidities is vital.

Dr. Siddarth Srivastava Professor Director at Gasetroentrology Department in GB Pant Hospital, a Super Specialty hospital too warned that what makes MASLD especially dangerous is that it’s often asymptomatic in early stages, progressing silently until irreversible damage has occurred.

Its not just a medical problem that needs to be addressed urgently, it can lead to reduced life expectancy, quality of life, and increasing healthcare needs and financial burden., Dr. Srivastava cautioned. “MASLD, has become the most common liver disease seen in children, can be a precursor to the development of Type 2 Diabetes (T2DM) and is the primary reason for liver transplant listing in young adults. We must be vigilant in prevention and treatment of MASLD in childhood to prevent further progression.”

In fact, its like you name it and the patient suffering with NAFLD have it. Severity of NAFLD is associated with a higher risk of developing chronic kidney disease (CKD). Ditto with sleep apnea, a disorder characterized by breathing interruptions during sleep, is also more common in patients with NAFLD.

The Government of India too has recognized this rising burden with the Union Health Ministry on its part, a few years ago integrating, MASLD/NAFLD into the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). Last year, it rolled out guidelines and training modules to empower frontline healthcare workers to help tackle the disease.

During the release of the guidelines, Apurva Chandra, the then Union Health Secretary said that “India has taken the lead in recognizing NAFLD as a major NCD…NAFLD is rapidly emerging as a major public health concern, closely linked with metabolic disorders such as obesity, diabetes and cardiovascular diseases. Out of 10, one to three people can have NAFLD which highlights the impact of the disease.”

In its guidelines, the Government has emphasized on the need to involve schools, parents, and policymakers. Nutritional education, improved food labeling, limiting sugary drinks, and replacing processed foods in school meals are essential steps.

Dr. Shalimaar who led a study in North India at a community level too remarked that to translate the goal as envisioned in the guidelines into reality is a huge task. The study published in Journal of Experimental and Clinical Hepatology in 2021 speaks all: Adults aged 30-60 years found to have a high prevalence of NAFLD: 65.7 per cent in urban and 61.1 per cent in rural. The prevalence among non-obese and obese children was 12.4 per cent and 63.4 per cent.

On the Government guidelines for the sector, Dr. Arun Gupta Pediatrician and Public Health Expert, Convener of National Advocacy Policy initiatives (NAPi), however, felt that more needs to be done.

“Throughout our healthcare system, we are constantly playing catch-up—waiting until illnesses manifest before acting,” he remarked adding “This reactive approach not only strains resources but also causes unnecessary suffering.”

“The surge in fatty liver disease among children and young adults is a warning we cannot ignore. This isn’t caused by one nutrient—it’s the result of a dietary pattern shaped by ultra-processed, high-fat, high-sugar foods aggressively marketed and consumed without caution.”

Junk food damages not just weight but the liver, often silently. The best prevention is public awareness—through bold, front-of-pack warning labels and restrictions on advertising, especially to children. Unless consumers are warned and protected, preventing will remain out of reach and we cannot expect informed or healthy choices, Dr. Gupta has been vociferously raising the issue at almost all the platforms.

While MASLD may have genetic and environmental roots too, early intervention remains a key.

Dr. Neelam Mohan summed up by emphasizing that prevention through early lifestyle intervention is the most effective strategy against this rising liver disease. She advised parents to encourage exclusive breastfeeding during infancy, promote outdoor play, ensure children get 8–10 hours of sleep, and limit screen time to no more than an hour daily. Additionally, she highlighted the importance of avoiding sugary drinks and processed snacks, while fostering a balanced diet rich in fruits, vegetables, and whole grains.

After all, “a healthy liver begins with a healthy lifestyle. Let’s protect it—early, consistently, and consciously," she quipped, emphasizing the importance of proactive care and mindful habits in maintaining liver health.