Pediatric Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is rapidly becoming the most common cause of chronic liver disease in children. This troubling statistic underscores the need for better management practices born out of a strong national vision. A recent study indicates that MASLD is prevalent in children, too. It is the leading cause for liver transplantations listings in young adults aged 18-40. Experts are understanding this condition better than ever before. They suggest a combination of treatment methods, including pharmacological and surgical strategies to increase the success rates for those suffering from it.
One of the biggest challenges in managing pediatric MASLD is poor screening. This routine failure to screen adequately can result in underdiagnosis, preventing patients from receiving timely interventions that address their needs. Leading experts all point to the need for early detection and proper management to avoid the long-term effects of this preventable condition.
Advances in Treatment Options
We support recently proposed approaches where metabolic bariatric surgery (MBS) has shown effective management of pediatric MASLD. This approach is especially advantageous for youth struggling with obesity and/or MASLD/NAFLD. This surgical therapy has been effective in decreasing steatosis and even reversing liver fibrosis in these patients. These results underscore the promising impact surgical interventions may have within a multimodal treatment plan for pediatric MASLD.
A recent multi-disciplinary, single center study of 111 children with MASLD. The outcomes demonstrated quite consistent and striking reductions in alanine aminotransferase (ALT) levels following treatment with the GLP-1 receptor agonists (RAs). These medications have not been specifically studied for pediatric MASLD thus far. Promising data from similar trials on pediatric obesity and diabetes indicate they may be key in controlling this growing epidemic.
GLP-1 RAs are highly effective agents for chronic weight management and treatment of indicators of metabolic dysfunction. They are able to lower cholesterol levels and blood pressure as well. There are critical contraindications that come with using them. These medications are contraindicated in people with a history of severe hypersensitivity. They are contraindicated in people with known personal or familial history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2.
The Role of Research and Collaboration
Jennifer A. Panganiban, MD, is the corresponding author of a recent review on managing MASLD in children. This review features perspectives from an interprofessional collective of clinical experts, including many members of the Obesity Medicine Association. This joint effort highlights the need for multidisciplinary collaborations to best address the complexities of pediatric MASLD.
Though the review brings to surface a plethora of important treatments modalities, it equally stresses the need for more research. It is critically important to have accurate and reliable non-invasive biomarkers. These biomarkers offer the potential to diagnose MASLD with non-invasive, objective measures and assess treatment response from available obesity medications.
Saul J. Karpen, MD, FAHA, is chief scientific officer at the Stravitz-Sanyal Institute for Liver Disease and Metabolic Health. Importantly, he underscored that continuous research is key to developing better treatment protocols and improving patient outcomes. As the understanding of pediatric MASLD continues to develop quickly, this important progress presents a valuable opportunity to improve management strategies that are better focused on younger patients.
Looking Ahead
As the conversation shifts toward pediatric MASLD, we call on @ the medical community to make screening and early intervention a priority. Overcoming the barriers that exist to both diagnosis and treatment will be essential in decreasing the occurrence of chronic liver disease in children. Improvement in medical and surgical therapies are coming. That is a promising sign that more impactful care will soon be available for those individuals with the most need.
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