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By: Dr. Mohit Kehar, hepatologist, CHEO
As families ready for back to school, I want to take a moment to talk about a disease affecting thousands of Canadian children, which is hiding in plain sight.
For years, "fatty liver disease" has been burdened by misconceptions that blame individuals for their illness and overlook the complex metabolic factors at play. To combat that stigma, experts recently adopted a new name — metabolic dysfunction-associated steatotic liver disease, or MASLD.
The label may have changed, but the challenge has not: MASLD is now the most common liver disease in children worldwide, and far too few people know.
At CHEO, the pediatric health centre of Canada’s capital, our liver clinic sees kids with MASLD who showed no obvious symptoms, but whose liver enzymes were abnormal. Families are often shocked and confused by the diagnosis.
Worldwide estimates suggest the disease affects roughly one in 10 kids. The risk is much higher in children who live with metabolic risk factors like obesity, high cholesterol, high blood pressure, sleep apnea, insulin resistance or type 2 diabetes.
The disease develops when fat builds up in the liver alongside these metabolic risk factors, but it can happen quicker for some than others. Genetics, sleep, stress, and screen time also play a part, in addition to some other environmental factors.
The challenge is that many children show no symptoms and for years, we’ve had limited information on what happened as children grew older while living with the disease.
Newer data shows that pediatric MASLD can develop into both heart disease and severe liver disease, which can include scarring in the liver, called fibrosis. This means the liver has been injured over time and has started to heal by forming scar tissue.
Early scarring may improve if the underlying injury is addressed. More advanced scarring can become harder to reverse and may eventually lead to a worsened condition called cirrhosis.
We can’t assume children will grow out of the disease. Children with persistent abnormal liver tests need medical support, follow-up, and, in some cases, further assessment by a specialist.
This is a system-wide call for change, backed by new national guidelines released this month. Better awareness for MASLD in kids is also an international effort where we need to push for better screening pathways, multidisciplinary care, and more research focused on kids.
Adult research has taught us a great deal, but children can’t be treated like small adults. Pediatric MASLD can look and progress differently and needs family-centred care.
At CHEO, we are trying to move this conversation forward in a practical and non-stigmatizing way to better understand the risk of liver scarring, and work with families on realistic next steps.
Families should ask whether liver screening is appropriate when risk factors are present. For us as clinicians, we need to take any abnormal results seriously. MASLD is common, but other liver diseases can look similar, and higher-risk children may need more assessment.
Recognition, research and intervention for kids should be a core part of how Canada responds, while policymakers and health system leaders need to make liver health a core topic for children, youth and families. Healthy activity, nutrition, and removing weight stigma all play an important role in that.
Pediatric MASLD is common, often silent, and not always benign. The earlier we recognize it, the better chance we have to change the story for children and avoid a life with advanced liver disease.