Pediatric nonalcoholic fatty liver disease (NAFLD) was first reported in 1983.  It is currently the primary form of liver disease among children.  NAFLD has been associated with the metabolic syndrome, which is a cluster of risk factors that contribute to the development of cardiovascular disease and type 2 diabetes mellitus. Studies have demonstrated that abdominal obesity and insulin-resistance in particular are thought to be key contributors to the development of NAFLD.      Because obesity is becoming an increasingly common problem worldwide, the prevalence of NAFLD has been increasing concurrently.  Moreover, boys are more likely to be diagnosed with NAFLD than girls with a ratio of 2:1.   Studies have suggested that progression toward a more advance stage of disease among children is dependent on age and presence of obesity.  This finding is consistent with previous studies in adults demonstrating the same association between age and obesity, and liver fibrosis.   Early diagnosis of NAFLD in children may help prevent the development of liver disease during adulthood.   This is challenging as most children with NAFLD are asymptomatic with few showing abdominal pain.  Currently, liver biopsy is considered the gold standard for diagnosing NAFLD.  However, this method is invasive, costly and bears greater risk for children, and noninvasive screening and diagnosing methods would have significant public health implications for children with NAFLD.  The only treatment shown to be truly effective in childhood NAFLD is weight loss.  
Physicians also warn about elevated liver enzyme levels due to oral anabolic steroid use. While that could show an inflammation of the liver, the issue is that some of the measured liver enzymes aren’t specific to the liver and exist in other tissues. For example, two enzymes found in liver, ALT and AST, also exist in muscle. Also any type of injury to a muscle including the kind that occurs with intense weight training can cause an elevation of those enzymes in the blood. A physician who’s not looking at the large picture or measuring levels of other liver and muscle enzymes may wrongly conclude that such liver enzyme increases are indicative of liver problems. Measuring enzymes such as creatine kinase and GGT would provide a more definitive picture of existing liver function, as would liver imaging tests.
Maybe you've had this scenario described to you by a customer: About an hour after dinner she begins to notice an uncomfortable sensation in her abdomen. She says the pain is cramplike, builds in intensity and shoots back toward her right shoulder blade. Nausea follows. She takes an antacid but wonders whether she has symptoms of appendicitis, food poisoning or an ulcer. A visit to her doctor reveals that she is actually suffering from complications of cholelithiasis, also known as gallstones.