Pediatric Fatty Liver: Common, But Not Stand-Alone
Pediatric fatty liver disease—also called metabolic dysfunction-associated steatotic liver disease—is the most common chronic liver condition affecting children worldwide. It also frequently occurs in children who have pediatric type 2 diabetes. Understanding the relationship between these two conditions could improve treatments and help young patients avoid significant health complications.
“Fatty liver and type 2 diabetes have an overlapping pathophysiology. Many studies show children with type 2 diabetes experience more aggressive disease, including earlier onset comorbidities,” says Natalie Segev, MD, MS, who will soon join the faculty as a clinician researcher in the Cincinnati Children’s Division of Diabetes and Endocrinology. “It’s similar with fatty liver. And we know that children who develop chronic diseases earlier and have earlier comorbidities will also need extensive medical care early on.”
To avoid these problems—and boost long-term outcomes for these patients—providers at Cincinnati Children’s take a multidisciplinary approach to care and are conducting innovative research.
The Pediatric Fatty Liver and Type 2 Diabetes Connection
Pediatric fatty liver impacts up to 20% of all American adolescents. And it’s present in roughly 30% of children who have type 2 diabetes. Both conditions are rooted in insulin resistance and obesity. In fact, up to 70% of US children with obesity also have fatty liver.
But providers still don’t have clarity about whether fatty liver is a risk factor or a consequence of type 2 diabetes, especially during puberty.
“Type 2 diabetes is becoming more prevalent in kids. And kids with type 2 are a lot less responsive to traditional medications than adults,” Dr. Segev says. “We need to understand how fatty liver in early life affects how the pancreatic beta cells (insulin producing cells) function in the development of type 2 diabetes.”
Knowing whether fatty liver is a modifiable risk factor that drives the development of type 2 diabetes, especially during puberty is critical, she says. It can help doctors identify and intervene with young patients who are at higher risk for complications and future irreversible disease.
Exploring the Impact of Pediatric Fatty Liver
Increased insulin resistance is a natural part of puberty, Dr. Segev says. For children with normal weight, it disappears when puberty ends. But children who are overweight or who have obesity struggle to achieve healthy insulin resistance, putting them at greater risk for type 2 diabetes.
In adults, the liver plays a big role in insulin resistance. So, to determine whether fatty liver is a precursor to pediatric type 2 diabetes, Dr. Segev is launching a study with collaborators in Endocrinology, Amy Shah, MD, MS, and in Gastroenterology, Marialena Mouzaki, MD, MSc, with young patients who are either overweight or who have obesity. After using advanced MRI imaging to confirm the presence of fatty liver and determining their baseline pancreatic beta cell functioning, they plan to follow their changes in pancreatic beta cell function over three years during puberty.
The goal of her investigation is two-fold. She hopes to:
- Assess the effects of puberty on pancreatic beta cell function in study participants with and without fatty liver
- Show that study participants with fatty liver have lower pancreatic beta cell function at baseline and a greater decline over time than children without the condition
This work has been funded by the Physician Hiring Acceleration for Scientific Talent (PHAST) Program at Cincinnati Children's Hospital Medical Center.
Expanding Pediatric Fatty Liver Treatment Options
Currently, treatments for fatty liver disease in children are limited to interventions that focus on improved nutrition and physical activity. But, due to genetic factors and some social determinants of health, these approaches don’t work for everyone.
For children with fatty liver, clarifying how these conditions are related could open the door to existing medications—GLP-1 receptor agonists.
“GLP-1 receptor agonists are approved treatments for pediatric diabetes and adult liver disease. We’re seeing that these medications are also effective for children with type 2 diabetes and fatty liver,” she says. “But it’s not yet FDA-approved for pediatric fatty liver alone. Making it available could help these children avoid liver scarring that can eventually lead to severe disease resulting in need for transplant.”
A Multidisciplinary Approach to Care
In addition to leading-edge research, Cincinnati Children’s is at the forefront of convenient, comprehensive care for patients who show signs of multiple metabolic diseases, such as pediatric fatty liver and type 2 diabetes. For patients with type 2 diabetes who have signs of fatty liver disease, such as persistent elevated levels of the liver enzyme alanine aminotransferase (ALT), providers deliver care through a multidisciplinary clinic. Nurse navigators also help patients schedule appointments and coordinate all tests, including advanced MRI imaging to confirm their diagnosis.
During a single appointment in one location, patients meet with their entire care team, which can include gastroenterologists, endocrinologists, preventive cardiologists, exercise physiologists and nutritionists. Together, they design a customized treatment plan that addresses each patient’s unique needs.
“In our type 2 diabetes multidisciplinary clinic established in 2018, every sub-specialist gets to know the patient. But we all tackle their appointments with our own expertise,” Dr. Segev says. “We try to understand what works for the patient because we know that the same nutrition and lifestyle counseling isn’t going to work for every person. We individualize it to what that person or family has access to or likes doing.”
Learn more about referring your patient.
(Published June 2026)
