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Pediatricians' practices and knowledge of metabolic dysfunction-associated steatotic liver disease: An international
Judith W Lubrecht1,2,3, Guusje H J van Giesen1,2, Wojciech Jańczyk4
1Centre for Overweight Adolescent and Children's Healthcare (COACH), Maastricht University Medical Centre+, MosaKids Children's Hospital, Maastricht, Netherlands.
Insights
Pediatricians show varied practices in diagnosing and treating metabolic dysfunction-associated steatotic liver disease (MASLD) in children. There is a significant need for updated, unified guidelines to improve care for this growing pediatric liver condition.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Public Health
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is the primary cause of pediatric chronic liver disease.
- MASLD is linked to serious intra- and extrahepatic comorbidities.
- Current guidelines lack consensus, leading to inconsistent care and potential underdiagnosis/undertreatment.
Purpose of the Study:
- To assess current pediatricians' practices in screening for MASLD in children.
- To evaluate the diagnostic approaches used for pediatric MASLD.
- To understand the range of treatments applied to children with MASLD.
Main Methods:
- An online survey was distributed to 454 pediatricians across Europe and Israel.
- The survey, conducted between June and November 2022, comprised 41 questions on MASLD management.
- Participants included pediatricians with and without subspecialty training.
Main Results:
- Only 51% of pediatricians use any MASLD guidelines, with 68% partially adhering.
- Screening commonly involves liver function tests and abdominal ultrasounds.
- Treatment approaches vary widely, including lifestyle changes, supplements, and pharmacotherapy (34%); 17% request liver biopsies in over 10% of cases.
Conclusions:
- European pediatricians exhibit limited awareness and diverse practices in MASLD screening, diagnosis, and treatment.
- There is a strong demand among clinicians for new, standardized guidelines for pediatric MASLD.
- Improved consensus and updated guidelines are crucial for effective management of pediatric MASLD.
Objective:
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease in children. It is associated with significant intra- and extrahepatic comorbidity. Current guidelines lack consensus, potentially resulting in variation in screening, diagnosis and treatment practices, which may lead to underdiagnosing and/or insufficient treatment. The increasing prevalence of MASLD and associated long-term health risks demand adequate clinical management and consensus in guidelines. This study aims to evaluate the daily practices of pediatricians in screening, diagnosis and treatment of MASLD in children.
Methods:
An online survey with 41 questions (single/multiple response options) was sent to pediatricians (with/without subspecialty) in Europe and Israel, via members of the ESPGHAN Fatty Liver Special Interest Group, between June and November 2022. The 454 pediatricians were included in this study.
Results:
51% of pediatricians indicated using any guideline for diagnosis and treatment of MASLD, with 68% reporting to follow recommendations only partially. 63% is of the opinion that guidelines need revision. The majority of pediatricians screen for MASLD with liver function tests and/or abdominal ultrasound. A large variety of treatment options is utilized, including lifestyle management, supplements and probiotics, with a notable 34% of pediatricians prescribing pharmacotherapy. When asked how often pediatricians request a liver biopsy in children with MASLD, 17% indicates they request a liver biopsy in more than 10% of cases.
Conclusions:
There is limited awareness and considerable variation in screening, diagnosis and treatment practices among European pediatricians, and a clear demand for new, uniform guidelines for MASLD in children.
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