Can You Be Born With a Fatty Liver?

Can you be born with a fatty liver? Yes, though it is uncommon and usually linked to specific underlying conditions rather than lifestyle. Fatty liver disease, or hepatic steatosis, occurs when fat accumulates in more than roughly 5 per cent of liver cells. In newborns, this can result from inherited metabolic disorders, maternal health conditions during pregnancy, or certain medicines taken during pregnancy. Understanding the causes, signs, and management options is important for parents and carers, as early identification and appropriate treatment can lead to significant improvement in a child's liver health.

Can you be born with a fatty liver?

Yes, it is possible to be born with a fatty liver, though it is uncommon and typically linked to inherited metabolic disorders or maternal health conditions during pregnancy rather than lifestyle factors.

Yes, it is possible to be born with a fatty liver, although this is uncommon and usually linked to specific underlying conditions rather than lifestyle factors. The liver normally contains a small amount of fat, but when fat accumulates in more than roughly 5 per cent of liver cells (hepatocytes), it is classified as fatty liver disease, known medically as hepatic steatosis. In newborns, this can occur as a result of metabolic or genetic disorders present from birth, maternal health conditions during pregnancy, or, in rare cases, as a consequence of certain medicines the mother received during pregnancy.

It is important to distinguish between fatty liver that is present at birth and fatty liver that develops in early childhood or later. The former is relatively rare and tends to be associated with identifiable inherited metabolic conditions. These cases are classified under the broader category of steatotic liver disease (SLD) of specific aetiology. The term metabolic dysfunction-associated steatotic liver disease (MASLD), now preferred in clinical practice over the older label non-alcoholic fatty liver disease (NAFLD), applies specifically to cases where recognised metabolic risk factors are present, and should not be used as an umbrella term for all forms of paediatric steatosis.^[1][2]

Parents and carers should be aware that a diagnosis of fatty liver in a newborn requires prompt investigation, as some underlying causes can be serious. With early identification and appropriate management, many children with fatty liver can achieve significant improvement. Any concerns about a newborn's liver health should be discussed with a paediatrician or GP without delay.

What causes fatty liver in newborns and young children?

Inherited metabolic disorders such as galactosaemia and fatty acid oxidation defects are the most significant causes in newborns, while obesity and excess caloric intake are the most common causes in older children.

Fatty liver in newborns and young children can arise from a range of genetic, metabolic, and environmental causes, and identifying the underlying reason is essential for guiding treatment. In neonates, inherited metabolic disorders are among the most significant contributors. Conditions such as galactosaemia, hereditary fructose intolerance, glycogen storage diseases, and fatty acid oxidation defects can all impair the liver's ability to process fats and sugars normally, leading to fat accumulation within liver cells.^[6]

Maternal factors during pregnancy also play a role. Gestational diabetes and obesity in the mother have been associated with altered fetal liver development and an increased risk of hepatic steatosis in the newborn. Infants born to mothers with poorly controlled diabetes may have higher levels of circulating insulin and fat, which can affect liver metabolism from the earliest days of life. Certain maternal infections during pregnancy have also been reported in association with neonatal liver changes, though the evidence base for this is less well established.

In older infants and young children, the causes broaden to include:

• Obesity and excess caloric intake, which is now the most common cause of fatty liver in children globally

• Rapid weight gain following periods of malnutrition or after certain medical treatments

• Prolonged total parenteral nutrition (TPN), used in premature or critically ill infants, which can cause parenteral nutrition-associated liver disease (PNALD), encompassing both cholestasis and steatosis

• Certain medicines, including long-term corticosteroids; parents should not stop or alter any prescribed medicine without first discussing this with the prescribing clinician

• Rare genetic syndromes such as Alstrom syndrome or Bardet-Biedl syndrome

If you suspect a medicine your child is taking may be affecting their liver, speak to your GP or specialist before making any changes. Suspected side effects of medicines can also be reported to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk.

Because the causes are so varied, a thorough clinical assessment is always necessary before any conclusions are drawn about an individual child's condition.

How is fatty liver diagnosed in infants and children in the UK?

Diagnosis involves clinical assessment, liver blood tests including ALT and AST, and abdominal ultrasound, with specialist tools such as transient elastography or liver biopsy reserved for complex cases.

Fatty liver in infants and children in the UK is typically diagnosed through a combination of clinical assessment, blood tests, and imaging, guided by NICE recommendations and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) guidance. A GP or paediatrician will usually begin with a detailed history, including family history of metabolic conditions, maternal health during pregnancy, and the child's growth and feeding patterns.

Blood tests form an important part of the initial investigation. Core liver blood tests include alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), albumin, and prothrombin time or INR (as a measure of synthetic function). A full blood count may also be requested. Depending on the clinical picture, additional tests may include fasting glucose and insulin levels, lipid profile, thyroid function, and, where clinically indicated, tests to exclude other causes such as viral hepatitis serology, autoimmune markers, ceruloplasmin (for Wilson's disease), and alpha-1 antitrypsin phenotype.

Ultrasound scanning of the abdomen is the most commonly used imaging tool in children, as it is non-invasive, does not involve radiation, and can detect increased echogenicity (brightness) of the liver, which is characteristic of fat accumulation. However, ultrasound has limitations in detecting mild steatosis and does not reliably quantify the degree of fibrosis.

In more complex cases, or where the diagnosis remains uncertain, a paediatric hepatologist may recommend:

• Transient elastography (FibroScan) with controlled attenuation parameter (CAP), a non-invasive tool used in secondary and tertiary care to assess both liver stiffness (fibrosis) and steatosis; paediatric expertise is required for accurate interpretation

• MRI-based fat quantification (MRI-PDFF), which is more sensitive than ultrasound but is typically available only in tertiary centres

• Liver biopsy, reserved for cases where the cause is unclear or where significant fibrosis is suspected

• Specialist metabolic testing to rule out inherited conditions

Referral to a specialist paediatric liver unit is appropriate when initial investigations suggest significant liver disease or when a rare metabolic cause is suspected.

What are the signs and health risks parents should watch for?

Pale stools, jaundice beyond 2 weeks, dark urine, and poor feeding in newborns require prompt review; untreated fatty liver can progress to fibrosis, cirrhosis, and increased metabolic disease risk.

Fatty liver in children is often silent in its early stages, meaning many children have no obvious symptoms, and the condition is discovered incidentally during investigations for another problem. However, parents and carers should be aware of certain signs that may prompt earlier medical review. These include persistent abdominal discomfort or a feeling of fullness in the upper right abdomen, unexplained fatigue, and, in some cases, a visibly enlarged abdomen.

In newborns, the following signs require prompt medical attention:

• Jaundice persisting beyond 2 weeks in term babies, or beyond 3 weeks in preterm or breast-fed babies, in line with NICE guidance on neonatal jaundice^[4]

• Pale or chalky (acholic) stools, which can indicate a problem with bile flow and require urgent same-day assessment to exclude conditions such as biliary atresia^[4]

• Dark urine, which alongside pale stools is a significant warning sign of liver or bile duct disease

• Poor feeding or failure to thrive

The longer-term health risks of untreated or unmanaged fatty liver in children are significant. Without intervention, fatty liver can progress through stages of increasing severity:

• Simple steatosis (fat accumulation without inflammation)

• Steatohepatitis (fat accumulation with liver inflammation, now termed MASH when associated with metabolic dysfunction)

• Fibrosis (scarring of liver tissue)

• Cirrhosis (advanced scarring, which can impair liver function)

Children with fatty liver are also at increased risk of developing type 2 diabetes, cardiovascular disease, and metabolic syndrome later in life, even if liver disease does not progress significantly.^[8]

Parents should contact their GP if a child shows signs of jaundice, persistent abdominal pain, pale stools, dark urine, unexplained weight loss, or swelling of the abdomen. If a child appears acutely unwell with confusion, severe vomiting, marked drowsiness, or other signs of liver failure, they should be taken to accident and emergency immediately or call 999. For non-urgent concerns or guidance outside of GP hours, NHS 111 can provide advice.

How is childhood fatty liver managed and treated on the NHS?

Management centres on lifestyle intervention and treating the underlying cause; there is no licensed medication for paediatric fatty liver in the UK, and a multidisciplinary team coordinates ongoing care.

Childhood fatty liver is managed on the NHS through a combination of lifestyle intervention, treatment of any underlying cause, and regular monitoring, with the approach tailored to the child's age, the severity of the condition, and its root cause. For children whose fatty liver is linked to obesity or excess caloric intake, the cornerstone of management is a structured programme of dietary change and increased physical activity, delivered with the support of a paediatric dietitian and, where appropriate, a specialist weight management service.

NICE guidance on weight management in children and young people recommends a whole-family approach, recognising that sustainable change is more achievable when parents and carers are actively involved.^[3] Dietary advice typically focuses on reducing ultra-processed foods, added sugars, and saturated fats, while encouraging a balanced diet rich in vegetables, wholegrains, and lean protein. There is currently no licensed medication specifically approved for fatty liver disease in children in the UK, and no over-the-counter supplements are recommended for paediatric fatty liver without specialist advice.^[9][10] Lifestyle modification remains the primary treatment.

Where an underlying metabolic or genetic condition is identified, management is directed at that specific disorder. For example, children with galactosaemia require a galactose-free diet, while those with fatty acid oxidation defects may need specialist dietary supplementation and careful management during illness. Parents should not stop or change any prescribed medicine, including corticosteroids, without first discussing this with the prescribing clinician, even if liver concerns arise.

Regular follow-up is important and typically includes monitoring of liver enzyme levels (ALT and AST), growth, and BMI-for-age centiles, alongside assessment for any progression of liver disease. Care is usually coordinated by a multidisciplinary team including a paediatrician, paediatric hepatologist, and dietitian, with specialist paediatric hepatology teams managing children with significant fibrosis or cirrhosis. In rare cases of liver failure, referral for liver transplantation assessment may be necessary.

Families seeking further information about weight management services or liver health support can speak to their GP, who can refer to appropriate NHS services based on local Integrated Care Board (ICB) commissioning arrangements.

Scientific References

1. Metabolic dysfunction-associated steatotic liver disease (MASLD) [formerly NAFLD]. NG49.
2. Assessment report: Rezdiffra (resmetirom) – EPAR public assessment report.
3. Overweight and obesity management. NG246.
4. Jaundice in newborn babies under 28 days. CG98.
5. Zeng J et al. Association of maternal obesity and gestational diabetes with offspring overweight/obesity and fatty liver.
6. Shekhawat PS et al. Fetal fatty acid oxidation disorders, their effect on maternal health and neonatal outcome.
7. Cao Y et al. Accuracy of controlled attenuation parameter (CAP) and liver stiffness measurement for assessing steatosis and fibrosis in NAFLD.
8. Newton KP et al. Diabetes in Children with Nonalcoholic Fatty Liver Disease. JAMA Pediatrics.
9. Resmetirom (Rezdiffra) authorised to treat metabolic dysfunction-associated steatohepatitis (MASH) in adults.
10. Non-alcoholic fatty liver disease (NAFLD).
11. Briefing paper: Non-alcoholic fatty liver disease (NAFLD). QS152.

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