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Pediatric MASLD: current understanding and practical approach
Anne-Sophie R Stroes1, Miriam Vos2, Marc A Benninga1
1Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Insights
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing concern in children, linked to obesity. New criteria and emerging treatments highlight the importance of early identification and management of this liver condition.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Metabolic Disorders
- Public Health
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading chronic liver disease in children globally, driven by increasing obesity rates.
- MASLD is associated with significant risks, including progressive liver damage, type 2 diabetes mellitus, and cardiovascular disease.
- Current challenges include underdiagnosis due to low awareness and the absence of straightforward diagnostic criteria.
Purpose of the Study:
- To review the epidemiology and risk factors of pediatric MASLD.
- To provide an evidence-based approach for screening, diagnosis, and treatment of MASLD in children.
- To highlight recent advancements in diagnostic criteria and emerging therapeutic options.
Main Methods:
- Literature review of current evidence and expert opinion on pediatric MASLD.
- Analysis of epidemiological data and risk factors.
- Synthesis of updated diagnostic guidelines and treatment strategies.
Main Results:
- MASLD is strongly associated with childhood obesity, overweight, and insulin resistance.
- New diagnostic criteria simplify the identification of MASLD, shifting it from a diagnosis of exclusion to a positive diagnosis.
- Emerging effective treatments for adults suggest potential future therapies for children.
Conclusions:
- Early identification of pediatric MASLD is crucial, especially with new diagnostic tools and potential treatments on the horizon.
- A proactive approach to screening, diagnosis, and management is needed to address the rising prevalence of MASLD.
- Further research is warranted to optimize treatment strategies for children with MASLD.
Abstract:
Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most prevalent chronic liver disease in children in industrialized countries mainly due to the rise in obesity and overweight. Besides risk of progressive liver damage, MASLD also carries an increased risk of extra-hepatic morbidity, most importantly type 2 diabetes mellitus and cardiovascular disease. Important challenges remain in the prevention, detection, and treatment of this prevalent disorder. This review outlines the epidemiology and risk factors of MASLD and provides an approach to screening, diagnosis, and treatment based on current best available evidence and expert opinion. What is known: • NAFLD/MASLD is a common disorder in children strongly related to obesity/overweight and insulin resistance. • This silent disorder is underdiagnosed due to lack of awareness and lack of simple diagnostic criteria. What is new: • New diagnostic criteria have transformed NAFLD/MASLD from a diagnosis of exclusion to a positive diagnosis with simple criteria. • Effective treatments are emerging for adults and will likely become available for children. • Identifying children with NAFLD/MASLD has become even more important due to this new treatment perspective.
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