Update in clinical science: MASLD in children and adolescents

Sander Lefere; Bart G P Koot; Jake P Mann; Philip Bufler; Ruth De Bruyne; Christian A Hudert

doi:10.1016/j.jhep.2026.02.016

Update in clinical science: MASLD in children and adolescents

J Hepatol. 2026 Feb 21:S0168-8278(26)00081-4. doi: 10.1016/j.jhep.2026.02.016. Online ahead of print.

Authors

Sander Lefere¹, Bart G P Koot², Jake P Mann³, Philip Bufler⁴, Ruth De Bruyne⁵, Christian A Hudert⁶

Affiliations

¹ Hepatology Research Unit, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Liver Research Center Ghent, Ghent University Hospital, Ghent, Belgium.
² Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
³ Department of Immunology & Immunotherapy, School of Infection, Inflammation and Immunology, College of Medicine and Health, University of Birmingham, UK; Liver Unit (including small bowel transplantation), Birmingham Women's and Children's NHS, Foundation Trust, Birmingham, UK.
⁴ Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Center for Child and Adolescent Health (DZKJ), partner site Berlin, Berlin, Germany.
⁵ Hepatology Research Unit, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ghent University Hospital, Ghent, Belgium.
⁶ Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité - Universitätsmedizin Berlin, Berlin, Germany. Electronic address: christian.hudert@charite.de.

PMID: 41730387
DOI: 10.1016/j.jhep.2026.02.016

Abstract

Paediatric metabolic dysfunction-associated steatotic liver disease (MASLD) is an increasingly common liver disease, with an estimated global prevalence of up to 7.5% and growing concern regarding hepatic and extrahepatic complications even in early life. In this paper, we review recent advances in epidemiology, genetics, early-life risk factors, natural history and comorbidities, focusing on emerging data published in the last 3 years. We also outline a practical approach to the management of MASLD in children, integrating newly developed non-invasive tests. Lastly, we highlight key research questions to be studied in the coming years.

Keywords: MASH; NIT; incretin mimetics; pediatric obesity; risk stratification.

Publication types

Review