The accumulation of excess fat in the liver is not solely a consequence of the combined effects of hereditary factors 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 to the child’s nutrition and metabolism.
Altogether 488 Finnish children were followed prospectively from early childhood into adolescence and retrospectively from the fetal period in the Physical Activity and Nutrition in Children (PANIC) study (www.panicstudy.fi) ongoing since 20 years at the University of Eastern Finland. 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 liver health and 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 be an importat predictor 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
In addition, 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 blood biomarkers analysed in the study. In contrast, 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.
“Our findings are also important for the future plans of the PANIC study," emphasizes Professor Timo Lakka of the University of Eastern Finland.
“In fact, in our long-term follow-up study – which began in childhood and continues into adulthood – we are currently striving to identify new biomarkers in both blood and subcutaneous adipose tissue that predict the development of MASLD and type 2 diabetes. The findings will help us better understand the early molecular mechanisms underlying the development of MASLD and type 2 diabetes, as well as explain the co-occurrence of these conditions – which are often linked to obesity – in the same individuals.”
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, which is part of the university’s Metabolic Diseases Research Community.
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. https://doi.org/10.1016/j.jpeds.2026.115146
For further information, please contact:
Timo Lakka, Professor of Medical Physiology, University of Eastern Finland, Institute of Biomedicine, Metabolic Diseases Research Community, [email protected], https://uefconnect.uef.fi/en/timo.lakka/
Professor Kalle Kurppa, Tampere University, [email protected]
Doctoral Researcher Hanna de Ruyter, Tampere University, [email protected]
