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Updates on paediatric MASLD: insights from an endocrine lens
Natalie Segev1,2, Marialena Mouzaki3,4
1Division of Diabetes and Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Diabetologia
|April 13, 2026
Summary
Paediatric metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health issue in children, linked to obesity and type 2 diabetes. Early detection and management are crucial due to severe health risks and distinct childhood disease patterns.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Metabolic Disorders
- Public Health
Background:
- Paediatric metabolic dysfunction-associated steatotic liver disease (MASLD) is the primary cause of chronic liver disease in children globally.
- Increasing rates of paediatric obesity and type 2 diabetes are driving the rise in MASLD.
- MASLD in children is influenced by obesity, metabolic dysfunction, early life exposures, genetics, and environmental factors.
Purpose of the Study:
- To review the epidemiology, pathophysiology, distinct features, and management of paediatric MASLD.
- To highlight the strong link between paediatric MASLD and youth-onset type 2 diabetes.
- To emphasize the need for paediatric-specific research and therapeutic trials.
Main Methods:
- Literature review and synthesis of current evidence on paediatric MASLD.
- Analysis of epidemiological data, including variations by sex and ancestry.
- Examination of histological differences between paediatric and adult MASLD.
Main Results:
- MASLD prevalence is higher in male and Hispanic youth, with increased severity when coexisting with glucose intolerance or type 2 diabetes.
- Paediatric MASLD exhibits unique histological patterns and significant fibrosis in 20-25% of cases.
- Puberty is a critical vulnerability period, exacerbating MASLD and type 2 diabetes due to insulin resistance and metabolic stress.
Conclusions:
- Paediatric MASLD is a distinct entity from adult disease with significant long-term health implications.
- Early life factors and puberty significantly influence the development and severity of paediatric MASLD and type 2 diabetes.
- Current management focuses on lifestyle changes, with emerging evidence for pharmacotherapy and bariatric surgery in select cases, necessitating further paediatric-specific trials.
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