Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 16:13:goaf056.
doi: 10.1093/gastro/goaf056. eCollection 2025.

Metabolic dysfunction-associated steatotic liver disease is associated with the risk of severe liver fibrosis in pediatric population

Wei Li  1 , Lina Jiang  1 , Meiling Li  1 , Chen Lin  2 , Li Zhu  1 , Bokang Zhao  3 , Yisi Liu  4 , Yan Li  1 , Yiyun Jiang  1 , Shuhong Liu  1 , Ping Liang  5 , Junqi Niu  3 , Jingmin Zhao  1
Affiliations

Metabolic dysfunction-associated steatotic liver disease is associated with the risk of severe liver fibrosis in pediatric population

Wei Li et al. Gastroenterol Rep (Oxf). .

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) has been proposed to replace the term of non-alcoholic fatty liver disease (NAFLD). To investigate the effect of MASLD on liver fibrosis and validate the clinical utility of MASLD criteria, differences in disease severity and clinical outcomes between MASLD and NAFLD were compared in a biopsy-proven pediatric cohort. The retrospective clinical data of 427 children with biopsy-proven steatotic liver between 2010 and 2021 were consecutively collected and categorized into three distinct subgroups of MASLD-only, NAFLD-only, and MASLD-NAFLD according to the diagnostic guidelines. Patients with MASLD-only and MASLD-NAFLD had more features of metabolic disorders, with higher level of triglycerides but lower level of high-density lipoprotein cholesterol than NAFLD-only. The proportion of significant fibrosis was highest in MASLD-only patients (68.0%), followed by those with MASLD-NAFLD and NAFLD-only (43.3% and 19.4%, respectively; P < 0.001). More steatohepatitis was presented in MASLD-NAFLD group than the other two groups (66.1% vs 30.8% vs 22.6%, P < 0.001). Multivariate regression revealed that children with MASLD-only had 5.8-fold greater risk of significant fibrosis than those with NAFLD-only (P = 0.001). After a median follow-up of 83 months, 14 of 427 patients developed clinical outcomes. Kaplan-Meier curves indicated no difference in the cumulative incidence of clinical events between the groups (log-rank, P = 0.073). Children in MASLD group tended to have concomitant with severe liver fibrosis and related metabolic diseases compared to those with NAFLD-only in pediatric cohort. Thus, the redefinition of MASLD may improve the detection of children with severe disease that need early intervention.

Keywords: fibrosis; liver biopsy; metabolic dysfunction-associated steatotic liver disease; non-alcoholic fatty liver disease; pediatric.

PubMed Disclaimer

Conflict of interest statement

The authors declare that there is no conflict of interests in this study.

Figures

Figure 1.
Figure 1.
Development of clinical outcomes or death stratified by steatotic liver status.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Younossi ZM, Kalligeros M, Henry L. Epidemiology of metabolic dysfunction-associated steatotic liver disease. Clin Mol Hepatol 2025;31:S32–50. - PMC - PubMed
    1. Maria FF, Ilaria F, Mohamad K et al. Converging pathways between metabolic dysfunction-associated steatotic liver disease (MASLD) and diabetes in children. Int J Mol Sci 2024;25:9924. - PMC - PubMed
    1. Paik JM, Kabbara K, Eberly KE et al. Global burden of NAFLD and chronic liver disease among adolescents and young adults. Hepatology 2022;75:1204–17. - PubMed
    1. Reddemma S, Suganya S, Priyanka G et al. Systemic impacts of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) on heart, muscle, and kidney related diseases. Front Cell Dev Biol 2024;12:1433857. - PMC - PubMed
    1. Keisuke S, Hak C, Samir S et al. The bidirectional immune crosstalk in metabolic dysfunction-associated steatotic liver disease. Cell Metab 2023;35:1852–71. - PMC - PubMed

LinkOut - more resources