Latino children with unreliable access to food at age 4 are nearly four times more likely to develop metabolic dysfunction-associated steatotic liver disease (MASLD, formerly known as non-alcoholic fatty liver disease) later in childhood, according to a study led by University of California San Francisco (UCSF) researchers.

Often referred to as “silent diseases,” MASLD and metabolic dysfunction-associated steatohepatitis (MASH) are responsible for a growing proportion of advanced liver disease, mirroring a global rise in obesity. MASLD is the leading cause of liver disease among children today, affecting up to 38% of children with obesity in the United States, according to the Mayo Clinic.

From 2021 to 2022, food insecurity in children in Latino households increased from 9.7% to 13.2%. In 2022, nearly 16% of children in Black households experienced food insecurity, up from 12% in 2021. Finally, 5.5% of children in white households in 2022 and 3.4% in 2021 had unreliable access to food, according to UCSF.

“We’ve seen studies in adults associating food insecurity with fatty liver disease and liver fibrosis, but very few studies have looked at children,” said lead study author Sarah Maxwell, MD, a pediatrician completing her pediatric transplant hepatology fellowship at UCSF Benioff Children’s Hospitals, in the news release. “This is especially important for Latinx children, who have both high rates of household food insecurity and fatty liver disease.”

Published in Pediatric Obesity, the study followed two groups of Latina mothers from pregnancy to when their children reached mid-childhood, one group from 2006 to 2007 and one from 2011 to 2013. Using the U.S. Household Food Security Food Module, researchers assessed MASLD in 136 children between ages 5 and 12 who then participated in annual visits until 2021.

Results showed 29% of children experienced food insecurity at age 4, and 27% had MASLD in early to middle childhood. What’s more, children with MASLD were more than twice as likely to live in food-insecure households (49%) at age 4 compared with children without MASLD (21%).

Overall, children facing food insecurity at age 4 were nearly four times more likely to develop MASLD by age 12, according to the study.

Although how food insecurity gives rise to fatty liver disease is not well understood, previous research suggests that children facing food insecurity may have diets high in processed or sweetened foods and drinks. Additionally, irregular eating patterns may disrupt their metabolism.


“Given our findings and how young patients are presenting with the condition to our liver clinics, we believe screening for MASLD should begin earlier than current guidelines recommend, which is ages 9 to 11 years for children with obesity and ages 2 to 9 years for those with severe obesity,” Maxwell said. “Food insecurity screening is also important early on, especially for Latinx children who are at higher risk and could be connected to healthier food resources in their communities.”

MASLD can lead to liver fibrosis, cirrhosis and even liver cancer. With no effective approved medical therapies, management depends on lifestyle changes such as weight loss and exercise. Previous research suggests limiting one’s intake of sugar-sweetened beverages and processed foods to protect against liver disease.


To learn more, click #MASLD or #Childhood Obesity. There, you’ll find headlines such as “FDA Approves First-Ever Drug for Fatty Liver Disease,” “Severe Obesity on the Rise in Young Latino Children” and “Food Insecure Teens Face Higher Risk of Liver Disease.”