Parizad R, Hatwal J, Brar AS, Alizadeh L, Goyal MK, Batta A, Mohan B. Interplay of childhood metabolic dysfunction-associated steatotic liver disease and obesity in the development of youth-onset type 2 diabetes. World J Clin Pediatr 2026; 15(1): 111030 [DOI: 10.5409/wjcp.v15.i1.111030]
Corresponding Author of This Article
Akash Batta, MD, DM, Department of Cardiology, Dayanand Medical College and Hospital, Tagore Nagar, Civil Lines, Ludhiana 141001, Punjab, India. akashbatta02@gmail.com
Research Domain of This Article
Endocrinology & Metabolism
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Systematic Reviews
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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/
Mar 9, 2026 (publication date) through Mar 9, 2026
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Journal Information of This Article
Publication Name
World Journal of Clinical Pediatrics
ISSN
2219-2808
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Parizad R, Hatwal J, Brar AS, Alizadeh L, Goyal MK, Batta A, Mohan B. Interplay of childhood metabolic dysfunction-associated steatotic liver disease and obesity in the development of youth-onset type 2 diabetes. World J Clin Pediatr 2026; 15(1): 111030 [DOI: 10.5409/wjcp.v15.i1.111030]
Razieh Parizad, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz 51656/87386, Iran
Juniali Hatwal, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Ajit Singh Brar, Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, MI 48503, United States
Leila Alizadeh, Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz 5166/15731, Iran
Manjeet Kumar Goyal, Department of Internal Medicine, Cleveland Clinic Akron General Hospital, Akron, OH 110029, United States
Akash Batta, Bishav Mohan, Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Author contributions: Parizad R performed the literature review and data collection; Parizad R and Batta A designed the review, analyzed the data and wrote the manuscript and subsequently revised it; Hatwal J, Brar AS, Alizadeh L, Goyal MK, and Mohan B supervised the manuscript and provided key feedback and suggestions; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Akash Batta, MD, DM, Department of Cardiology, Dayanand Medical College and Hospital, Tagore Nagar, Civil Lines, Ludhiana 141001, Punjab, India. akashbatta02@gmail.com
Received: June 23, 2025 Revised: July 24, 2025 Accepted: October 28, 2025 Published online: March 9, 2026 Processing time: 258 Days and 15.3 Hours
Abstract
BACKGROUND
The global increase in childhood and adolescent obesity has significantly contributed to the rising prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) – a condition now recognized as a key metabolic complication in youth. MASLD significantly increases the risk of youth-onset type 2 diabetes (T2D), particularly among obese individuals. Its asymptomatic progression presents considerable challenges for timely diagnosis and intervention.
AIM
To review epidemiology, pathophysiological mechanisms, and management strategies related to pediatric MASLD, exploring its interaction with obesity and youth-onset T2D.
METHODS
A comprehensive literature search was conducted using PubMed, Scopus, and Google Scholar to identify peer-reviewed studies published between 2015 and 2025. Keywords included “pediatric MASLD”, “childhood obesity”, “youth-onset type 2 diabetes”, “hepatic insulin resistance”, and “noninvasive biomarkers”. Articles were selected based on relevance, methodological quality, and focus on human pediatric populations.
RESULTS
MASLD affects approximately 13% of children globally and up to 47% of those with obesity, with the highest prevalence reported in urban areas of the United States, China, and India. In children and adolescents, excess adiposity is the leading contributor to hepatic steatosis and metabolic dysfunction, particularly when body mass exceeds standard growth benchmarks for age and sex. MASLD increases the risk of adolescent T2D by approximately 2.7-fold. Key pathophysiological mechanisms include hepatic insulin resistance, mitochondrial dysfunction, and chronic inflammation, driven by lipotoxic metabolites such as ceramides and pro-inflammatory cytokines. Lifestyle modifications – particularly low free-sugar diets and structured physical activity – have demonstrated moderate efficacy in reducing hepatic fat and improving metabolic outcomes. Pharmacologic interventions, including glucagon-like peptide-1 receptor agonists such as liraglutide and semaglutide, show potential for weight reduction and glycemic control, though their effects on hepatic histology remain under investigation.
CONCLUSION
MASLD represents a critical metabolic threat in pediatric populations, strongly influenced by obesity and closely associated with increased risk of youth-onset T2D. Effective management requires early detection, multidisciplinary interventions, and equitable access to care. Future research should prioritize the validation of noninvasive diagnostic tools, development of targeted therapies, and reduction of socioeconomic and ethnic disparities in disease burden and treatment outcomes.
Core Tip: The global increase in childhood and adolescent obesity has significantly contributed to the rising prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) – a metabolic complication with significant extrahepatic manifestations in the youth. MASLD represents a critical metabolic threat in pediatric populations, strongly influenced by obesity and is closely associated with increased risk of youth-onset type 2 diabetes (T2D). This comprehensive literature search synthesizes the current evidence on the epidemiological trends, pathophysiological mechanisms, psychological impact, diagnostic challenges, management and prevention strategies related to MASLD in the pediatric population, with particular emphasis on its interplay with obesity and youth-onset T2D.
