Updates in Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) in Children

Abstract

The obesity epidemic is one of the major health concerns of the 21 st century. Non-alcoholic fatty liver disease (NAFLD) is linked with the increased adiposity associated with obesity. NAFLD has become the most frequent cause of chronic liver disease in adults and children worldwide. Metabolic dysfunction-associated fatty liver disease (MAFLD) also known in children as paediatric fatty liver disease type 2 has begun to supersede NAFLD as the preferred nomenclature in the paediatric population. Evidence suggests the aetiology of MAFLD is multifactorial, related to the complex interplay of hormonal, nutritional, genetic, and environmental factors. Current limitations in accurate diagnostic biomarkers have rendered it a diagnosis of exclusion and it is important to exclude alternative or co-existing causes of paediatric fatty liver disease. Lifestyle changes and modifications remains the primary treatment modality in MAFLD in children. Weight loss of 7-10% is described as reversing MAFLD in most patients. The Mediterranean diet also shows promise in reversing MAFLD. Pharmacological intervention is debatable in children, and though paediatric trials haven’t shown promise, other agents undergoing adult clinical trials show promise. This review outlines the latest evidence in paediatric MAFLD and its management.

Goodbye, NAFLD, hello, MASLD?!

“…Understandably, some patients and providers may be disappointed or frustrated by the new nomenclature. Previously, in 2020, an international expert consensus group had proposed metabolic dysfunction associated fatty liver disease, which included similar diagnostic criteria of evidence of hepatic steatosis in the setting of cardiometabolic risk factors 12 . However, MASLD reflects the most recent nomenclature revision, and involved stakeholders from over 50 countries.…”

The Reduced Gut Lachnospira Species Is Linked to Liver Enzyme Elevation and Insulin Resistance in Pediatric Fatty Liver Disease

“…The condition stems from multiple factors, such as genetic predisposition, unhealthy dietary patterns, lifestyle choices, and environmental and societal influences [1][2][3]. Childhood obesity poses a substantial risk for the development of adult obesity and several severe medical conditions, such as type 2 diabetes, cardiovascular disease, and metabolic dysfunction-associated fatty liver disease (MAFLD) [4][5][6]. Furthermore, childhood obesity has been linked to the emergence of various non-metabolic health issues, such as certain types of cancers, obstructive sleep apnea, asthma, infertility, polycystic ovary syndrome, orthopedic complications, and psychiatric disorders [7][8][9][10].…”

From NAFLD to MAFLD to MASLD: Looking for the Best Pediatric Label

“…What is even more relevant is that much of the knowledge about the natural history and management of NAFLD/MAFLD, documented in adulthood, has been translated to pediatric patients tout court. The risks of this translation are the leitmotif of this commentary on the review by Rupasinghe et al (5) which, in this issue of JPGN, focuses on MAFLD in childhood, its pathogenesis, differential diagnosis, and management. In particular, it draws attention to the conditions that can determine MAFLD but also to those that can mimic it.…”

“…Even if this new nomenclature offers a clearer scenario, a certain ambiguity remains for the metabolic term which is seen with different eyes by the adult hepatologist (who thinks primarily of the pathogenetic mechanisms of steatosis and above all of insulin resistance) and the pediatric hepatologist (who instead thinks mainly of inborn errors of metabolism responsible for fatty liver disease). In the Rupasinghe review, MAFLD is contextualized in the pediatric fatty liver and it stressed the importance of distinguishing the pediatric fatty liver type 2 from other causes, especially the inborn errors of metabolism that evidently play a minor role in adulthood (5).…”