Treatment response in pediatric metabolic dysfunction-associated steatotic liver disease: Noninvasive endpoints and body composition

Figure 1 Multidimensional, treatment-aware framework for assessing response in pediatric metabolic dysfunction-associated steatotic liver disease. No single biomarker defines response. Liver injury, steatosis, fibrosis risk, adiposity and muscle, cardiometabolic and growth outcomes, and patient-centered safety outcomes should be interpreted separately, with attention to treatment modality, time horizon, growth and puberty, technical conditions, feasibility, and equity. A three-tier approach aligns minimum clinical assessment, specialist-center assessment, and research endpoints. The framework and reassessment timing shown are author-proposed pragmatic guidance and have not been externally validated. MASLD: Metabolic dysfunction-associated steatotic liver disease; ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transferase; MRI-PDFF: Magnetic resonance imaging proton density fat fraction; MRE: Magnetic resonance elastography; VCTE: Vibration-controlled transient elastography; GLP-1: Glucagon-like peptide-1; BP: Blood pressure.