Why some adults under 50 may develop early-onset cirrhosis from fatty liver disease

by University of California - San Diego

edited by Swati Mestri, reviewed by Robert Egan

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Researchers at the University of California San Diego School of Medicine have published the first study to define early-onset cirrhosis caused by metabolic dysfunction-associated steatotic liver disease (MASLD), a condition known as fatty liver disease.

The study results, published Sept. 16, 2026, in the online edition of Clinical Gastroenterology and Hepatology, found that people who develop cirrhosis before age 50 have a distinct risk profile shaped by inherited genetic factors and metabolic conditions, specifically type 2 diabetes.

"Our findings show that younger adults who develop cirrhosis from MASLD are not simply experiencing the same disease earlier," said Rohit Loomba, M.D., senior author of the study, a gastroenterologist and hepatologist at UC San Diego Health and chief of the Division of Gastroenterology and Hepatology at UC San Diego School of Medicine.

"They appear to have a unique combination of genetic susceptibility and metabolic risk factors that accelerate progression to advanced liver disease."

Using data from about 2,400 adults with biopsy-confirmed MASLD enrolled in the national NASH Clinical Research Network, investigators found that approximately 25% of cirrhosis cases occurred before age 50. The study defined this group as having "early-onset MASLD cirrhosis" and identified key risk factors associated with the condition.

Although cirrhosis typically develops later in life, some individuals progress to advanced liver scarring much sooner, and little has been known about why. The findings also highlight limitations in current screening approaches. Many commonly used liver fibrosis assessment tools incorporate age, which may reduce their sensitivity in younger patients.

In the study, nearly one-third of participants with early-onset cirrhosis had scores that would not typically trigger further evaluation using standard screening thresholds.

"As current screening tools incorporate age, they miss almost a third of patients with early-onset MASLD cirrhosis," said Veeral Ajmera, M.D., first author of the study, a hepatologist at UC San Diego Health and associate professor of medicine at UC San Diego School of Medicine.

"This study helps us identify which patients are at greatest risk and need a more accurate assessment of their liver disease."

"Cirrhosis is frequently silent until serious complications develop," Loomba said.

"These results suggest that younger adults with type 2 diabetes, obesity or elevated genetic risk may benefit from more proactive liver assessment."

Loomba, a member of UC San Diego Moores Cancer Center, added that cirrhosis is an important risk factor for hepatocellular carcinoma, the most common form of liver cancer. Identifying high-risk patients earlier may create opportunities for appropriate cancer surveillance and intervention before liver cancer develops.

The authors said the study provides a foundation for improving risk prediction and screening strategies and advancing more personalized approaches to liver disease prevention and treatment.

As rates of obesity and type 2 diabetes continue to rise, researchers expect MASLD-related liver disease to become increasingly common, emphasizing the need to identify those most likely to progress to an advanced stage of the disease.

Publication details

Clinical Gastroenterology and Hepatology (2026). DOI: 10.1016/j.cgh.2026.08.033

Journal information: Clinical Gastroenterology and Hepatology

Key medical concepts

Non-alcoholic fatty liver diseaseCirrhosisDiabetes Type 2

Clinical categories

GastroenterologyCommon illnesses & Prevention Provided by University of California - San Diego Who's behind this story?

Swati Mestri

Swati Mestri holds a bachelor's degree in Electronics Engineering and has worked as a content editor since 2019. She has experience editing research documents across technology, health care, and materials science, and has a particular interest in technology and space. Full profile →

Robert Egan

Bachelor's in mathematical biology, Master's in creative writing. Well-traveled with unique perspectives on science and language. Full profile →

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