Prenatal health and early diet may shape fatty liver risk, study suggests

The accumulation of excess fat in the liver is not solely a consequence of the combined effects of hereditary and adult lifestyle-related factors. A new study by researchers at Tampere University and the University of Eastern Finland indicates that both maternal health during pregnancy and early-life nutrition may have long-term implications for children’s liver health.

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 the child’s nutrition and metabolism.

The study followed 488 Finnish children from early childhood into adolescence. The researchers analyzed 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. The findings are published in The Journal of Pediatrics.

“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 onward.

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 analyzed 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.

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