Fatty liver disease in children (MAFLD/PeFLD Type 2): unique classification considerations and challenges

Area of Science:

• Pediatric Hepatology
• Metabolic Disorders
• Liver Disease

Background:

• Fatty liver disease in children frequently overlaps with inherited metabolic disorders (IMDs), necessitating precise diagnosis and management.
• Metabolic dysfunction-associated fatty liver disease (MAFLD), previously non-alcoholic fatty liver disease (NAFLD), is a liver manifestation of a multisystemic condition diagnosed by metabolic dysfunction criteria.
• In children, MAFLD diagnosis often involves excluding IMDs, with the possibility of future IMD identification even with initially negative investigations.

Purpose of the Study:

• To provide a clinical perspective on pediatric fatty liver disease, emphasizing its relationship with metabolic dysfunction.
• To highlight the diagnostic challenges and the need for individualized management strategies in pediatric fatty liver disease.
• To underscore the increasing prevalence of MAFLD in children and adolescents and the current gaps in understanding and awareness.

Main Methods:

• Review of current clinical perspectives on pediatric fatty liver disease.
• Analysis of diagnostic criteria differentiating MAFLD from IMDs in children.
• Discussion of the complexities in managing pediatric fatty liver disease, including genetic, epigenetic, and psychosocial factors.

Main Results:

• MAFLD is the most common cause of liver disease in children and adolescents, affecting approximately 7% of this population.
• Classification of pediatric fatty liver disease includes MAFLD (PeFLD type 2) and cases requiring consideration for undiagnosed IMDs (PeFLD type 3).
• The management of pediatric fatty liver disease is complex and requires a personalized approach due to various influencing factors.

Conclusions:

• Accurate differentiation between MAFLD and IMDs is critical for appropriate management in children.
• An individualized approach is essential for managing pediatric fatty liver disease, considering its multifaceted nature.
• Increased awareness and further research are needed to address the growing prevalence and complexities of MAFLD in pediatric populations.