Nutrition in Pediatric Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

Lifestyle change, including weight loss in children with overweight and obesity, through intensive health behavior and lifestyle treatment (IHBLT) is one of the main pillars in the management of pediatric metabolic dysfunction-associated steatotic liver disease (MASLD). Approximately 10% of school-aged children in the United States-and an even higher percentage of children with obesity-are affected by MASLD. The stigma, combined with peer and society pressure to maintain a "healthy" weight, as it pertains to MASLD, has led a percentage of affected children to adapt restrictive patterns of eating that have culminated in malnutrition, nutrient deficiencies, disordered eating, anxiety and mood, and eating disorders. Prompt recognition through screening and targeted interventions is needed to address this crisis. Our paper offers a concise review and approach to the nutrition evaluation and assessment of malnutrition and nutrition deficiencies in children with pediatric obesity and MASLD and addresses interventions considered to mitigate this health outcome. We reviewed the literature pertaining to pediatric MASLD and malnutrition, nutrient deficiencies, eating behaviors, eating disorders, disordered eating, and food insecurity in the pediatric population. We focused on the evaluation, assessment, and management of malnutrition and nutrition and behavioral interventions recommended in pediatric MASLD. Overall, IHBLT alone has not been sufficient to curb the pediatric obesity and MASLD epidemic, and there has been a growing interest in specific pediatric MASLD pharmacotherapies and their related nutritional and behavioral side effects. Ultimately, assessing and addressing nutrient deficiencies, mood disturbances, and disordered eating behaviors is critical to mitigating the long-term consequences of this disease, while improving food access and distribution can further optimize metabolic health outcomes through high-quality nutrition.