Fighting the epidemic of pediatric metabolic dysfunction-associated steatotic liver disease: Role of non-invasive diagnostics and early pharmacological intervention

Abstract

The global rise in childhood obesity has made metabolic dysfunction-associated steatotic liver disease (MASLD) the leading cause of pediatric liver disease. Studies have consistently reported alarmingly high rates of advanced fibrosis in up to 20% of adolescents with MASLD. There is evidence that pediatric MASLD may run a more severe clinical course compared to adults, as well as pose an independent risk factor for mortality than pediatric obesity or type 2 diabetes mellitus alone. This underscores the necessity for timely recognition, accurate diagnosis and early institution of therapeutic interventions for pediatric MASLD. In this minireview, we discuss the various non-invasive diagnostic modalities used for the evaluation of MASLD, and propose an updated diagnostic and monitoring algorithm incorporating recent multi-societal statements. The advent of non-invasive diagnostics such as vibration-controlled transient elastography in children allows for earlier recognition of liver fibrosis, and may prioritize the need for early pharmacological therapy. We also discuss the importance of early pharmacological intervention in pediatric MASLD, in particular the use of glucagon-like peptide 1 receptor agonists which may have potential to halt MASLD progression if instituted early, and the potential role for novel anti-fibrotic therapy in this population.

Keywords: Pediatric metabolic dysfunction-associated steatotic liver disease; Glucagon-like peptide 1 receptor agonists; Vibration-controlled transient elastography; Resmetirom; Pediatric obesity

Core Tip: The escalating prevalence of pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) mirrors the rise in pediatric obesity. The advent of non-invasive diagnostics may allow for earlier recognition of liver fibrosis, and may prioritize the need for early pharmacological therapy. We propose an updated diagnostic and monitoring algorithm incorporating recent multi-societal statements in pediatric MASLD. The increased use of weight-loss pharmacotherapy such as glucagon-like peptide 1 receptor agonists in adolescent patients has shown efficacy in inducing weight loss, which may have potential in halting MASLD progression if instituted early in the disease course.