Risk factors for fatty liver disease may begin to develop as early as the prenatal period and early childhood
A population-representative longitudinal study demonstrates that early indicators of metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as fatty liver disease, may be linked to both maternal health in the prenatal period and to the child’s nutrition and metabolism.
The study followed altogether 488 Finnish children from early childhood into adolescence. The researchers analysed maternal health during pregnancy alongside the child’s diet, lifestyle, body composition and metabolism to examine the associations between prenatal and lifestyle factors and alanine aminotransferase (ALT) levels, an early indicator of MASLD.
“One of our key findings was that maternal pre-pregnancy hypertension may be associated with elevated ALT levels in the child, both in childhood and adolescence. This suggests that maternal cardiometabolic health in the prenatal period may contribute significantly to the development of MASLD in the offspring. However, further studies are required to definitively establish this causal relationship,” says Hanna de Ruyter, Doctoral Researcher at Tampere University and lead author of the study.
The study also found that the child’s body composition – especially visceral adiposity, which is consistent with the current hypothesis – was associated with elevated ALT levels from early childhood onwards. In addition, a shorter duration of breastfeeding and earlier introduction of solid foods were linked to higher ALT levels in adolescence.
A high intake of animal-based foods tied to increased ALT levels
The study also highlighted the role of dietary factors in the development of MASLD. A diet high in protein, animal-based foods and dairy products was associated with higher ALT levels, particularly in later childhood and adolescence, whereas a high intake of fruit, vegetables and berries was linked to lower ALT levels. These findings were supported by the metabolic biomarkers analysed in the study.
No statistically significant association was found between ALT levels and the child’s physical activity, fitness or sleep.
Although most children in the cohort were healthy and the prevalence of MASLD was low, elevated ALT levels were observed in approximately 12–15% of them. This is noteworthy, as increased ALT levels may signal the development of liver disease and metabolic syndrome later in life.
“While these findings should be interpreted with caution and replicated in other cohorts, the study provides important new insights into the early-life origins of MASLD. The findings may, in time, contribute to the development of preventive strategies that address risk factors even before the onset of liver disease,” says Professor Kalle Kurppa of Tampere University.
The study was conducted in collaboration between the Child and Adolescent Health Promotion group at Tampere University and the Physical Activity and Nutrition in Children (PANIC) study at the University of Eastern Finland.
The research article titled “Perinatal and Lifestyle Factors Associated with Childhood Alanine Aminotransferase Levels as an Early Indicator of MASLD” was published in n The Journal of Pediatrics on 12 May 2026. The article is available online
Further information
Kalle Kurppa
kalle.kurppa [at] tuni.fi (kalle[dot]kurppa[at]tuni[dot]fi)
Hanna de Ruyter
hanna.deruyter [at] tuni.fi (hanna[dot]deruyter[at]tuni[dot]fi)
