Metabolic Dysfunction-Associated Steatohepatitis (MASH)

MASH is less common than MASLD but is becoming more frequent in children and teens, especially those with obesity or other related health conditions. While many children with MASLD don’t develop liver damage, about 10–20% may go on to develop MASH.  

MASH is caused by the same metabolic problems that lead to MASLD. These include: 

• Obesity
• Insulin resistance, prediabetes or type 2 diabetes 
• High cholesterol or triglycerides 
• Poor diet and low physical activity 

MASH is caused by the liver becoming overworked from storing too much fat, which triggers inflammation and damage.

If caught early, MASH can be improved—and sometimes reversed—through healthy lifestyle changes alone. These changes can reduce fat in the liver, lower inflammation, and help prevent long-term liver damage. 

Like MASLD, many children with MASH typically don’t have symptoms. When symptoms do occur, they may include belly pain, especially in the upper right side.

Because it often causes no symptoms, MASH is usually detected through routine testing ordered by a primary care provider.

If not treated, MASH can lead to: 

• Liver fibrosis (scarring) 
• Cirrhosis (severe scarring that affects liver function) 
• Liver failure (in rare, advanced cases) 
• Higher risk of heart disease or type 2 diabetes 

Early diagnosis and treatment are vital to avoid these complications.  

Doctors use several tools to check for MASH, often starting with a physical exam and medical history. Diagnosis usually involves the following tests: 

Blood Tests

Liver function tests (ALT, AST): Check for liver inflammation or damage 

Imaging Tests

Abdominal ultrasound: Looks for fat in the liver 

Liver Biopsy (in some cases)

During a liver biopsy, a small sample of liver tissue is taken to confirm inflammation or scarring. This is the most accurate way to diagnose MASH but is usually only done when needed. 

There’s no single medicine that cures MASH, but lifestyle changes can make a big difference. Treatment may include: 

• Healthy eating: A diet with less sugar, processed foods, and saturated fats 
• Regular physical activity: At least 1 hour a day of movement, like walking or sports 
• Weight management: A safe weight loss plan if your child is overweight 
• Medical care: Some children may benefit from seeing a liver specialist, dietitian, or endocrinologist 

Doctors may also treat related conditions like high cholesterol or insulin resistance.

At Lurie Children’s, our specialists in the Metabolic Dysfunction-Associated Steatohepatitis (Fatty Liver Disease) Program treat children with MASH. 

MASH is often preventable. Families can lower a child’s risk by: 

• Encouraging a healthy diet from a young age 
• Limiting sugary drinks and snacks 
• Promoting daily physical activity 
• Going to regular check-ups to monitor weight, growth, and lab work  

The outlook for MASH depends on how early the condition is found and treated. If caught early and managed well, many children can reverse liver inflammation and prevent serious complications. Without treatment, MASH can lead to long-term liver problems in adulthood. 

Ongoing care, healthy habits, and regular monitoring can help your child stay on track and protect their liver for life.