Children with Liver Disease Face Dramatically Higher Risk of Early Death

The risk of death was higher in certain children, especially boys and those with low levels of high-density lipoprotein (HDL), often called the “good” cholesterol. Nearly half of the deaths were caused by liver disease itself, while others were due to heart-related conditions, accidents or suicide.

In addition to the risk of early death, many children in the study developed serious health problems while still in their teens or twenties. These included high blood pressure (14%), obstructive sleep apnea (9.5%) and type 2 diabetes (7.3%). Problems with blood fats, such as high triglycerides or low HDL, were even more common — making dyslipidemia, the presence of abnormal levels of fats (lipids) in the blood, the most frequent complication overall.

While many children showed improvement with clinical care, a substantial portion still experienced disease progression. The findings highlight how much we have yet to learn about the natural course of MASLD in children and reinforce the need for better tools to detect, monitor and manage this condition.

“We have shown that MASLD in children is a serious disease with life-threatening potential,” Schwimmer said. “Our hope is that these findings lead to greater awareness and stronger investment in pediatric-specific diagnostics, treatments and systems of care. With the right tools and commitment, we can make a meaningful difference in outcomes.”

Future research is needed to identify which children are at highest risk for progression to cirrhosis and early death, and to determine how lifestyle, medication or surgical interventions might change the disease course. For now, researchers emphasize that early recognition, consistent follow-up and greater public and provider awareness remain critical to protecting the health of children with MASLD.

Read the full study.

Additional co-authors on the study include: Nhat Quang N. Thai, M.P.H., Sheila L. Noon, Patricia Ugalde-Nicalo, M.D., Sabina R. Anderson, Lauren F. Chun, M.D., Nidhi P. Goyal, M.D., Kimberly P. Newton, M.D., Eleanor G. Hansen, M.D., Bonnie Lin, Warren L. Shapiro, M.D., Andrew Wang, D.O., Elizabeth L. Yu, M.D., Cynthia A. Behling, M.D., Ph.D. from UC San Diego; and Rhys S. David from Rady Children’s Hospital.

The study was funded, in part, by the National Institutes of Health (UL1TR001442), the Rady Children’s Hospital San Diego Physician Fund and a research grant from Intercept Pharmaceuticals.

No conflict of interest to disclose.