MASLD In Children - A Distinct Phenotype?

PURPOSE OF REVIEW: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a pattern shift in the classification and understanding of fatty liver disease in adults as well as children, overtaking the previous concept of non-alcoholic fatty liver disease (NAFLD). The adoption of MASLD places a central role of metabolic dysregulation, aligning with the diagnosis and clinical features with underlying cardiometabolic risk factors. Pediatric MASLD requires important focus due to its rising prevalence almost affecting up to 14% of children globally, and over 1/3 of children with obesity because of its distinct pathophysiological, histological, and clinical features compared to adult-onset disease. RECENT FINDINGS: Studies reported that there is a major difference between pediatric and adult MASLD from epidemiology to genetic and metabolic factors to histopathology, and clinical expression. In children, periportal steatosis and fibrosis is prevalent, while in adults the centrilobular pattern is prevalent. Early-life exposures such as maternal obesity, rapid postnatal weight gain, and epigenetic factors amplify pediatric risk and shape the disease phenotype. Socioeconomic status, environmental factors, and sedentary behavior together elevate the pediatric incidence and severity. Due to unique histologic patterns, there are numerous problems associated with diagnosis and treatment. Also, a lack of non-invasive biomarkers and the need for individualized, pediatric-specific treatments that meet both medical and developmental needs should be focused on. Pediatric MASLD comprises a complex clinical and biological phenotype when compared to the adult MASLD in progression and metabolic context. This highlights an urgent need for pediatric-focused research, appropriate diagnostic strategies, and development-specific management protocols. Addressing these gaps is critical to manage the growing burden of MASLD among children worldwide and to improve long-term health outcomes as this population matures into adulthood.