Call to action-Pediatric MASLD requires immediate attention to curb health crisis

Phillipp Hartmann^{1

2}, Marialena Mouzaki³, Sara Hassan⁴, Mohit Kehar⁵, Krupa R Mysore⁶, Erin Mauney⁷, Dieudonne Nonga⁸, Sara Karjoo^{9

10

11}, Shilpa Sood¹², Andrea Tou¹³, Christine Brichta¹⁴, Rachel E Herdes¹⁵, Nikhil Pai¹³, Donna K Garner⁶, Mary E Rinella¹⁶, Mazen Noureddin¹⁷, Zobair Younossi^{18

19

20}, Alina M Allen²¹, Arun Sanyal²², Taisa Kohut²³, Rohit Kohli²⁴, Charina M Ramirez⁴, Stavra Xanthakos³, Miriam B Vos²⁵, Jeffrey B Schwimmer^{1

2}, Samar H Ibrahim²⁶, Jennifer Panganiban¹³

Affiliations

¹ Department of Pediatrics, University of California San Diego, La Jolla, California, USA.
² Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego, California, USA.
³ Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
⁴ University of Texas Southwestern, Dallas, Texas, USA.
⁵ Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Canada.
⁶ Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
⁷ Tufts Medical Center, Boston, Massachusetts, USA.
⁸ Nationwide Children's Hospital, Columbus, Ohio, USA.
⁹ Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
¹⁰ Department of Pediatrics, University of South Florida, Tampa, Florida, USA.
¹¹ Department of Pediatrics, Florida State University, Tallahassee, Florida, USA.
¹² Division of Pediatric Gastroenterology, Boston Children's Health Physicians, New York Medical College, Valhalla, New York, USA.
¹³ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹⁴ Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
¹⁵ Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Stanford University School of Medicine, Stanford, California, USA.
¹⁶ Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, Illinois, USA.
¹⁷ Houston Methodist Hospital, Houston Research Institute, Houston, Texas, USA.
¹⁸ The Global NASH/MASH Council, Washington, DC, USA.
¹⁹ Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA.
²⁰ Center for Outcomes Research in Liver Disease, Washington, DC, USA.
²¹ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
²² Virginia Commonwealth University, Richmond, Virginia, USA.
²³ AdventHealth Medical Group Pediatric Advanced Hepatology and Liver Transplant, Orlando, Florida, USA.
²⁴ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital Los Angeles, California, USA.
²⁵ Division of Gastroenterology, Department of Pediatrics, Hepatology and Nutrition, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
²⁶ Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

PMID: 40550108
PMCID: PMC12236211 (available on 2026-06-23)
DOI: 10.1097/HEP.0000000000001440

Call to action-Pediatric MASLD requires immediate attention to curb health crisis

Phillipp Hartmann et al. Hepatology. 2025.

. 2025 Jun 23:10.1097/HEP.0000000000001440.

doi: 10.1097/HEP.0000000000001440. Online ahead of print.

Authors

Affiliations

¹ Department of Pediatrics, University of California San Diego, La Jolla, California, USA.
² Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego, California, USA.
³ Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
⁴ University of Texas Southwestern, Dallas, Texas, USA.
⁵ Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Canada.
⁶ Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
⁷ Tufts Medical Center, Boston, Massachusetts, USA.
⁸ Nationwide Children's Hospital, Columbus, Ohio, USA.
⁹ Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
¹⁰ Department of Pediatrics, University of South Florida, Tampa, Florida, USA.
¹¹ Department of Pediatrics, Florida State University, Tallahassee, Florida, USA.
¹² Division of Pediatric Gastroenterology, Boston Children's Health Physicians, New York Medical College, Valhalla, New York, USA.
¹³ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹⁴ Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
¹⁵ Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Stanford University School of Medicine, Stanford, California, USA.
¹⁶ Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, Illinois, USA.
¹⁷ Houston Methodist Hospital, Houston Research Institute, Houston, Texas, USA.
¹⁸ The Global NASH/MASH Council, Washington, DC, USA.
¹⁹ Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA.
²⁰ Center for Outcomes Research in Liver Disease, Washington, DC, USA.
²¹ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
²² Virginia Commonwealth University, Richmond, Virginia, USA.
²³ AdventHealth Medical Group Pediatric Advanced Hepatology and Liver Transplant, Orlando, Florida, USA.
²⁴ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital Los Angeles, California, USA.
²⁵ Division of Gastroenterology, Department of Pediatrics, Hepatology and Nutrition, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
²⁶ Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

PMID: 40550108
PMCID: PMC12236211 (available on 2026-06-23)
DOI: 10.1097/HEP.0000000000001440

Abstract

Pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) has become more prevalent on a global scale over the last decades and is associated with significant comorbidities in childhood and a 40-fold higher risk of early mortality in young adulthood. MASLD has now become the leading indication for liver transplantation in young adults in the United States. However, pediatric MASLD is still perceived as an indolent condition by many patients, families, and clinicians. In this Call to Action, we aim to raise awareness of pediatric MASLD as a public health crisis. Herein, we describe insufficient screening and disease staging practices, and a lack of accurate non-invasive tests and effective pharmacotherapy, both stemming from a paucity of multicenter clinical trials in pediatric MASLD. We provide clear steps to address this public health emergency by promoting awareness campaigns, educating and empowering patients and families, addressing barriers including access to care, nutritional and exercise support programs, establishing multidisciplinary care, launching community initiatives, and conducting clinical trials in pediatric MASLD for an age-based evaluation of novel diagnostic and therapeutic options. We conclude by highlighting the urgent need for comprehensive public health policies to control the tide of pediatric MASLD and call upon stakeholders to act now.

Keywords: diagnostics; pediatric MASLD; public health; therapeutics.

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Conflict of interest statement

Declarations:

Competing interests: Marialena Mouzaki received grants from Soy Nutrition Institute. Mohit Kehar consults for and advises Mirum. Erin Mauney received grants from Tryp Therapeutics.Sara Karjoo is on the speakers’ bureau for Abbott Nutrition, Ipsen, Mirum, and Nutricia. Nikhil Pai is on the speakers’ bureau for Abbott and Takeda. Mazen Noureddin consults for, received grants from, and owns stock in Akero. He consults for and received grants from Boehringer Ingelheim, and Boston. He consults for Alligos and AstraZeneca. He received grants from Allergan, Altimmune, BMS, and Conatus. He owns stock in Chronwell. Zobair Younossi consults for Madrigal, Siemens, and Novo Nordisk. He owns stock in Boehringer Ingelheim, Sanofi, and Abbott. Alina Allen consults for and received grants from Novo Nordisk and Madrigal. She consults for Boehringer Ingelheim, 89 Bio, and GSK. She received grants from Siemens, Oncoustics, and Escopics. Arun Sanyal consults for and received grants from Genfit. He consults for Eli Lilly, Echosens, Abbott, Promed, Genfit, Satellite Bio, Corcept, Arrowhead, Boston, Variant, Cascade, 89 Bio, AstraZeneca, Alnylam, Regeneron, Boehringer Ingelheim, BMS, Genentech, Gilead, Histoindex, Janssen, Lipocine, Madrigal, Merck, GSK, Novartis, Akero, Novo Nordisk, Path AI, Histoindex, Pfizer, Poxel, Salix, Myovant, Median Technologies, Sequana, Surrozen, Takeda, Terns, and Zydus. He received grants paid to his institution from AstraZeneca, BMS, Gilead, Intercept, Mallinckrodt, Merck, Ocelot, Bovartis, and Salix. He received grants from Durect, Tiziana, and Inversago. He received royalties from Elsevier and UpToDate. Rohit Kohli consults for Mirum, Sanofi, Ipsen, Madrigal, and EiCure. He received grants from Epigen. Charina M. Ramirez consults for Mirum. Strava Xanthakos consults for Madrigal. Miriam B. Vos consults for Boehringer Ingelheim, Eli Lilly, Boston, Madrigal, Inventiva, and Alberio. She advises Thiogenesis and Target RWE. She received grants from Sonic Incytes. She owns stock in Terns. The remaining authors have no conflicts to report.

References

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Call to action-Pediatric MASLD requires immediate attention to curb health crisis

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Call to action-Pediatric MASLD requires immediate attention to curb health crisis

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