Yodoshi T. Digital twins in pediatric metabolic dysfunction-associated steatotic liver disease: Developmentally referenced multimodal risk stratification. World J Hepatol 2026; 18(10): 125486 [DOI: 10.4254/wjh.125486]
Corresponding Author of This Article
Toshifumi Yodoshi, MD, PhD, Assistant Professor, Division of Gastroenterology, Hepatology, Pancreatology and Nutrition, University of Iowa Stead Family Children’s Hospital, No. 200 Hawkins Drive, Iowa, IA 52242, United States. toshifumi-yodoshi@uiowa.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Oct 27, 2026; 18(10): 125486 Published online Oct 27, 2026. doi: 10.4254/wjh.125486
Digital twins in pediatric metabolic dysfunction-associated steatotic liver disease: Developmentally referenced multimodal risk stratification
Toshifumi Yodoshi
Toshifumi Yodoshi, Division of Gastroenterology, Hepatology, Pancreatology and Nutrition, University of Iowa Stead Family Children’s Hospital, Iowa, IA 52242, United States
Author contributions: Yodoshi T conceived the review, performed the literature search, verified and synthesized the evidence, developed the conceptual framework and figure, drafted and critically revised the manuscript, and approved the final version.
AI contribution statement: AI tools were not used during manuscript preparation.
Conflict-of-interest statement: The author declares no conflicts of interest related to this article.
Corresponding author: Toshifumi Yodoshi, MD, PhD, Assistant Professor, Division of Gastroenterology, Hepatology, Pancreatology and Nutrition, University of Iowa Stead Family Children’s Hospital, No. 200 Hawkins Drive, Iowa, IA 52242, United States. toshifumi-yodoshi@uiowa.edu
Received: July 8, 2026 Revised: August 10, 2026 Accepted: September 8, 2026 Published online: October 27, 2026 Processing time: 105 Days and 10.6 Hours
Core Tip
Core Tip: Pediatric metabolic dysfunction-associated steatotic liver disease is dynamic, but routine monitoring relies heavily on isolated measurements. No validated pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) digital twin currently exists. This review separates direct pediatric MASLD evidence from adult, other-pediatric, and generic digital-twin evidence and proposes an author-derived, investigational architecture. A minimum viable core should begin with routinely available developmental, anthropometric, laboratory, treatment, and clinically obtained imaging data, with advanced imaging, body composition, genetics, multi-omics, microbiome, and digital phenotyping added only as separately validated modules. Near-term research should emphasize association-based prognostic monitoring, explicit uncertainty, missing-not-at-random data, false alerts and false reassurance, and silent prospective validation. Treatment-effect simulation requires separate causal validation and should not be inferred from ordinary risk prediction.
