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(a)Liver pathology (hematoxylin-eosin staining x100). A high degree of fat deposition consisting of large and small droplets spread over the whole liver lobule and a small number of centrilobular ballooning hepatocytes are observed. Mild lymphocyte infiltration accompanied by mild fibrosis is also observed, but bridging fibrosis is not seen. Therefore, the pathological stage of NASH is considered to be type 3 according to the Matteoni classification43).(b)Kidney pathology (Periodic acid-Schiff staining x400). Glomerular diameter shows hypertrophy (normal range of diameter: 100-150μm). A glomerulus with increased mesangial matrix, hyaline deposition, and obliterated capillary lumen is observed.titative urine glucose test 1,000 [0-20] mg/dL). Since the absolute liver Hounsfield Unit (HU) value on computed tomography (CT) was 20 to 50, moderate steatosis was expected (Figure 1). Liver and kidney biopsies were performed for further evaluation, indicating significant lipid accumulation in both organs and secondary glomerular sclerosis in the kidney (Figure 2). Based on these findings, he was diagnosed with obesity, non-alcoholic steatohepatitis (NASH), diabetes mellitus, and chronic kidney disease. Dietary therapy and medi-cation (metformin, alpha-glucosidase inhibitor, 514Figure 2　Histological findings of the liver and kidneyvalsartan, and febuxostat) were started immedi-ately after the diagnosis, but insulin therapy was needed two years later because of treatment resis-tance. The suspected mechanism of the develop-ment of metabolic syndrome in this case is shown in Figure 3.Japanese Epidemiology and Risk Factors Currently, the number of children born with LBW in Japan is increasing, in spite of the decrease in the number of births. According to the popula-tion statistics of the Ministry of Health, Labor and Welfare [https://www.mhlw.go.jp/toukei/list/dl/ 81-1a2.pdf [accessed July 28, 2021] (in Japanese)], the percentage of LBW infants in Japan decreased steadily after World War II, dropping to 5% of around 1975-1980. Since then, the percentage of LBW infants of total births has been increasing, reaching 7% in the 1990s, the same level as in the postwar period, and it has been around 9.5% since 2005. As a result, the current average birth weight of both males and females has decreased by about 200 g compared to the 1975-1980 period.According to the National Health and Nutrition Examination Survey [https://www.mhlw.go.jp/Figure 3　Relationship between fetal growth restriction and metabolic syndromeThe thrifty phenotype acquired by fetal growth restriction during the maternal-fetal period continues to adversely affect various organs even after birth, increasing the risk of developing lifestyle-related diseases.DM: diabetes mellitus, LBWI: low-birth weight infant, FGR: fetal growth restriction, SGA: small for gestational age, NALFD: nonalcoholic fatty liver disease, NASH: nonalcoholic steatohepatitis, CKD: chronic kidney disease.for LBW infants