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A natural history study of paediatric non-alcoholic fatty liver disease over 10 years
Laura Draijer1,2,3, Maaike Voorhoeve1, Marian Troelstra4
1Department of Pediatric Gastroenterology and Nutrition, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands.
Insights
Childhood obesity often leads to persistent non-alcoholic fatty liver disease (NAFLD). After 10 years, 6% of young adults with NAFLD developed advanced liver fibrosis, highlighting the need for monitoring.
Area of Science:
- Hepatology
- Pediatric Endocrinology
- Obesity Medicine
Background:
- Long-term outcomes of pediatric non-alcoholic fatty liver disease (NAFLD) remain under-established.
- A cohort of 133 children with severe obesity was screened for NAFLD between 2008-2012.
Purpose of the Study:
- To determine the 10-year natural history of NAFLD in a cohort of severely obese children.
- To assess longitudinal changes in liver steatosis and fibrosis.
- To explore risk factors associated with NAFLD progression.
Main Methods:
- 10-year follow-up of 133 children with severe obesity originally screened for NAFLD.
- Proton magnetic resonance spectroscopy (¹H-MRS) used to assess liver steatosis.
- Enhanced Liver Fibrosis® (ELF) test employed to evaluate liver fibrosis progression.
Main Results:
- 38% of the original cohort (51 participants) were included in the follow-up.
- Steatosis prevalence remained stable at 47%, with equal proportions developing or resolving steatosis.
- 6% of participants with NAFLD developed advanced fibrosis; ELF test changes correlated with triglyceride levels.
Conclusions:
- Childhood obesity and associated NAFLD frequently persist into young adulthood.
- A significant minority (6%) of young adults with NAFLD progress to advanced fibrosis.
- Regular screening and monitoring for NAFLD progression in obese youth are crucial.
Background & Aims:
The long-term outcome of paediatric non-alcoholic fatty liver disease (NAFLD) has not been well established. Between 2008 and 2012, an unselected cohort of 133 children with severe obesity was screened for NAFLD. The aim of this study was to determine the 10-year natural history of NAFLD in this cohort.
Methods:
All 133 participants of the original study were approached. Proton magnetic resonance spectroscopy (1H-MRS) and the Enhanced Liver Fibrosis® (ELF) test were used to assess longitudinal changes in steatosis and fibrosis, respectively. Risk factors for disease progression were explored.
Results:
Fifty-one of the 133 participants (38%) from the original cohort were included. The mean follow-up time was 10.3 years (range 7-13 years), 65% were female and 92% had persistent obesity. The proportion of participants with steatosis remained unchanged (47%). Nine individuals developed steatosis and in nine individuals steatosis resolved. Predefined relevant individual changes in 1H-MRS were seen in 38% of the participants. The mean ELF test did not change significantly (8.70 ± 0.58 vs. 8.51 ± 0.71, p = 0.22). However, 16% had a relevant increase in ELF test and 6% of those with NAFLD developed advanced fibrosis at follow-up. Changes in steatosis correlated with changes in established metabolic risk factors, alanine aminotransferase, and bariatric surgery. A change in the ELF test was associated with a change in triglycerides.
Conclusions:
This 10-year follow-up study shows that one-third of the young adults who had childhood obesity develop steatosis and in one-third steatosis resolves. Six percent of those with NAFLD had developed advanced fibrosis at follow-up. These data underscore the importance of screening for NAFLD and monitoring for progression to advanced NAFLD in young people with obesity.
Impact And Implications:
Childhood obesity accompanied by fat accumulation in the liver persists into young adulthood in the vast majority, and 6% develop serious liver injury. Worsening of metabolic disturbances increases the risk of liver injury.
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