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Defining paediatric metabolic (dysfunction)-associated fatty liver disease: an international expert consensus

Mohammed Eslam1, Naim Alkhouri2, Pietro Vajro3

  • 1Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, Australia.

The Lancet. Gastroenterology & Hepatology
|August 8, 2021
PubMed

Insights

The current definition of non-alcoholic fatty liver disease (NAFLD) is inadequate for children. A new framework and age-appropriate definition for metabolic (dysfunction)-associated fatty liver disease (MAFLD) are proposed for improved pediatric care.

Area of Science:

  • Hepatology
  • Pediatric Gastroenterology
  • Metabolic Disorders

Background:

  • Non-alcoholic fatty liver disease (NAFLD) definitions present challenges, particularly for pediatric populations where alcohol consumption is not a factor.
  • Existing NAFLD definitions are problematic for children, necessitating a re-evaluation for accurate diagnosis and care.
  • Metabolic (dysfunction)-associated fatty liver disease (MAFLD) has been proposed as a new definition for adults with metabolic dysregulation.

Purpose of the Study:

  • To propose an overarching framework for pediatric fatty liver diseases.
  • To introduce an age-appropriate definition for metabolic (dysfunction)-associated fatty liver disease (MAFLD) in children.
  • To provide a conceptual scaffold for diagnosis, risk stratification, and multidisciplinary care of pediatric fatty liver diseases.

Main Methods:

  • An international panel reviewed existing definitions and proposed a new framework.
  • Development of age- and sex-percentile-based diagnostic criteria for pediatric MAFLD.
  • Consideration of coexisting systemic fatty liver diseases in children within the proposed framework.

Main Results:

  • The proposed framework acknowledges the complexities of fatty liver diseases in children.
  • New MAFLD diagnostic criteria are presented, tailored for pediatric populations.
  • The revised definition aims for consistency and validity across all age groups.

Conclusions:

  • The proposed MAFLD definition and framework offer a more accurate and clinically useful approach for pediatric fatty liver disease.
  • These advancements support improved diagnosis, risk stratification, and comprehensive care for children.
  • The new definition aligns with a lifespan approach to fatty liver disease management.

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