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Long-term mortality and extrahepatic outcomes in 1096 children with MASLD: A retrospective cohort study
Jeffrey B Schwimmer1,2, Nhat Quang N Thai3,4, Sheila L Noon1,5
1Division of Gastroenterology, Department of Pediatrics, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California, USA.
Insights
Pediatric Metabolic dysfunction-associated steatotic liver disease (MASLD) leads to significant early death and serious health issues. Early detection and management are crucial for improving outcomes in children with MASLD.
Area of Science:
- Pediatric Hepatology
- Metabolic Disorders
- Chronic Liver Disease
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease in children.
- Long-term outcomes and mortality associated with pediatric MASLD remain inadequately understood.
Purpose of the Study:
- To quantify mortality rates in pediatric MASLD.
- To identify primary causes of death in this population.
- To evaluate the incidence of cirrhosis and extrahepatic complications.
Main Methods:
- Retrospective cohort study of 1096 children (aged 2-18) diagnosed with MASLD between 2000-2017.
- Utilized the National Death Index for mortality ascertainment.
- Assessed comorbidities through medical records and follow-up visits over a mean of 8.5 years.
Main Results:
- Overall mortality rate was 398 per 100,000 person-years, with nearly half of deaths being liver-related.
- Cumulative incidence of cirrhosis was 4.7%.
- High rates of extrahepatic comorbidities observed: dyslipidemia (3664), hypertension (1901), obstructive sleep apnea (1185), and type 2 diabetes (911) per 100,000 person-years.
Conclusions:
- Pediatric MASLD is linked to considerable premature mortality and a high burden of liver and non-liver related complications.
- Findings underscore the necessity for prompt screening, early intervention, and sustained management strategies for pediatric MASLD.
Background And Aims:
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease in children, but its long-term outcomes are poorly understood. This study aimed to quantify mortality rates, identify causes of death, and evaluate the incidence of cirrhosis and extrahepatic outcomes in children with pediatric-onset MASLD.
Approach And Results:
The Longitudinal InVestigation Evaluating Results of Steatosis (LIVERS) study is a single-center, retrospective cohort study conducted at Rady Children's Hospital San Diego. We included 1096 children aged 2-18 years who were diagnosed with MASLD between 2000 and 2017 and followed for a mean of 8.5 years. Mortality was ascertained through the National Death Index, and comorbidities were assessed through follow-up research visits and medical records. Overall, 3.4% of children died, yielding a mortality rate of 398 per 100,000 person-years; nearly half of these deaths were liver-related. Male sex and lower HDL levels independently predicted increased mortality risk. The cumulative incidence of cirrhosis was 4.7%. High incidence rates of extrahepatic comorbidities were observed, including dyslipidemia (3664 per 100,000 person-years), hypertension (1901), obstructive sleep apnea (1185), and type 2 diabetes (911).
Conclusions:
Pediatric MASLD is associated with significant premature mortality and a substantial burden of hepatic and extrahepatic comorbidities. These findings highlight the need for timely screening, early intervention, and long-term management strategies to improve outcomes for children with MASLD.
