Vitamin D supplementation for pediatric steatotic liver disease: A systematic review and meta-analysis

This review aimed to systematically evaluate the evidence from interventional studies for the effects of vitamin D supplementation on hepatic and metabolic parameters in children with metabolic dysfunction-associated steatotic liver disease (MASLD).

MEDLINE, Scopus, Web of Science, and clinical trial registers were systematically searched using MeSH terms until April 30, 2025. Study selection, data extraction, and assessment of risk of bias (ROB 2 and ROBINS-I) were performed independently by two reviewers. Random-effects meta-analysis was used to pool mean differences (MDs) for hepatic and metabolic outcomes. Sensitivity analyses were used to examine the robustness of obtained results.

Data from 10 studies were included. Despite the lack of improvement in hepatic fibrosis (MD = -0.03; 95% CI -0.20, 0.13), Non-alcoholic fatty liver disease (NAFLD) activity scores improved (MD = -2.41; 95% confidence interval [CI] -3.59, -1.23). Estimates for reduction in alanine aminotransferase (ALT) for participants with MASLD (MD = -12.16; 95% CI -21.09, -3.2) suggested improvements that may overlap with clinical benefit. Improvements in glucose regulation, lipid profile, and body mass index z-scores were also noted for children with MASLD.

Interventional evidence suggests possible hepatic benefits for vitamin D supplementation in deficient MASLD children and adolescents, with or without additional metabolic benefits. Significant inconsistencies regarding the magnitude of effect, and the low quality of evidence precludes recommendations for change in clinical practice beyond a more targeted evaluation of vitamin D status in at-risk populations, and supplementation where otherwise indicated. Future trials examining vitamin D for pediatric MASLD and exploring subgroups further benefiting from the intervention may be warranted.