AASLD Practice Statement on the evaluation and management of metabolic dysfunction-associated steatotic liver disease in children

Abstract

Given the high prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in children and its distinct epidemiological, clinical, and histopathological differences from adult disease, the American Association for the Study of Liver Diseases (AASLD) commissioned this pediatric-focused evidence-based practice statement. A multidisciplinary writing group—encompassing expertise in pediatric hepatology, gastroenterology, endocrinology, and liver pathology—conducted a comprehensive PubMed literature search for studies published through March 6, 2024, involving pediatric participants (ages 0–18 y) with NAFLD or MASLD. The review addressed epidemiology, pathophysiology, natural history, screening, diagnosis, treatment, comorbidity management, outcome monitoring, and transition of care. Using the highest available level of evidence—randomized controlled trials, large observational cohort studies, systematic reviews, and meta-analyses—30 evidence-guided practice statements were developed. Where high-quality evidence was lacking, expert consensus was employed, and critical knowledge gaps were identified to inform future research priorities. This document highlights key concepts relevant to pediatric MASLD, especially regarding diagnostic criteria, noninvasive assessment tools, and therapeutic approaches. It also discusses the implications of the 2023 nomenclature revision, which emphasizes evaluating both hepatic steatosis and cardiometabolic risk factors. With increasing recognition of MASLD’s cardiometabolic burden and long-term health consequences, this practice statement provides a structured framework to advance clinical care and research in pediatric MASLD.