Digital twins in pediatric metabolic dysfunction-associated steatotic liver disease: Developmentally referenced multimodal risk stratification

Figure 1 Author-proposed, investigational layered architecture for a developmentally referenced pediatric metabolic dysfunction-associated steatotic liver disease digital twin. The figure distinguishes a minimum viable core of routinely available inputs from optional research modules and separates association-based prognostic prediction from a causal simulation module that would require independent validation. Candidate outputs are research targets and do not constitute validated clinical guidance. MASLD: Metabolic dysfunction-associated steatotic liver disease; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; BMI: Body mass index; HbA1c: Hemoglobin A1c; GLP-1 RA: Glucagon-like peptide-1 receptor agonist; MRI-PDFF: Magnetic resonance imaging proton density fat fraction; MRE: Magnetic resonance elastography; BIA: Bioelectrical impedance analysis; DXA: Dual-energy X-ray absorptiometry; MNAR: Missing not at random; SHAP: Shapley additive explanations.