April 2026
Paternal as well as maternal excess prepregnancy weight linked with MASLD in adult offspring
By Rebecca Jenkins
Prepregnancy excess weight in both mothers and fathers is associated with an increased risk of metabolic dysfunction associated steatotic liver disease (MASLD) in adult offspring, a study finds, with childhood adiposity a substantial mediator.
MASLD, defined in this study as hepatic steatosis on transient elastography (FibroScan) with one or more cardiometabolic risk factors, is the most common chronic liver disease globally, and might originate early in life, researchers wrote in Gut.
Although population-based cohort studies had shown the importance of maternal obesity in offspring MASLD risk, the role of paternal obesity and the potential mediating role of childhood adiposity were unclear, they noted.
Analysing data from almost 2000 offspring from a prospective UK birth cohort study, the researchers found 10.4% had MASLD at 24 years of age, based on FibroScan results plus cardiometabolic risk factors.
Prepregnancy maternal and paternal obesity were each independently associated with an increased odds of offspring MASLD in a linear dose-response relationship.
Each 1 kg/m2 increase in maternal body mass index (BMI) increased the odds of MASLD by 10%, and each 1 kg/m2 increase in paternal BMI raised the odds by 9%.
Offspring with two parents who had overweight or obesity before pregnancy had 3.73 times the odds of MASLD, when compared with offspring of parents with a normal BMI.
The researchers highlighted that 67% of this association was mediated by cumulative excess childhood BMI, suggesting a ‘potential of life course interventions aimed at reducing the risk of MASLD later in life and for future generations’.
Professor Elizabeth Powell, Hepatologist at Princess Alexandra Hospital, Brisbane, and Clinical Director, QIMR Berghofer Medical Research Institute, Brisbane, said parental weight, and metabolic health generally, were linked to adult offspring liver disease through multiple, interacting mechanisms.
These mechanisms operated before conception, during gestation and early life, and across childhood and adolescence.
‘This study provides some of the strongest human evidence to date that paternal weight before conception independently predicts offspring MASLD risk, with effect sizes similar to maternal BMI,’ Professor Powell told Medicine Today.
‘The implication for practice is that preconception conversations should explicitly include fathers and that paternal weight should not be framed as "irrelevant background risk".’
In addition, Professor Powell highlighted that about two-thirds of the risk link between biparental obesity and offspring MASLD in the study was mediated by cumulative excess BMI throughout childhood, not fixed prenatal or genetic effects.
‘Therefore, the main pathway is modifiable, reinforcing the importance of long-term obesity prevention, family-based lifestyle interventions and sustained weight trajectories, not single BMI measurements,’ Professor Powell said.
The study also reaffirmed that MASLD was not a ‘middle-aged disease’ and young adults with obesity deserved proactive metabolic and liver risk assessment, she said.
For further information, Professor Powell recommended clinicians refer to the Gastroenterological Society of Australia (GESA) consensus statement on metabolic dysfunction-associated fatty liver disease (MAFLD), the consensus term for MASLD in Australia (https://www.gesa.org.au/resources/clinical-practice-resources/metabolic-dysfunction-associated-fatty-liver-disease-mafld-consensus-statement/).