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Gómez-Mendoza et al. Metab Target Organ Damage. 2025;5:24 Metabolism and
DOI: 10.20517/mtod.2024.108
Target Organ Damage

Perspective Open Access

Fatty liver disease in the pediatric population:
history, definitions, and challenges in nomenclature

(NAFLD/MAFLD/MASLD)

Raúl Gómez-Mendoza, Fabiola Sánchez-Hernández, Francisco Javier Valentin-Cortez, Norberto Chávez-
Tapia
Obesity and Digestive Diseases Unit, Medica Sur, Mexico City 14050, México.
Correspondence to: Dr. Norberto Chavez-Tapia, Obesity and Digestive Diseases Unit, Medica Sur, Puente de Piedra 150, Mexico
City 14050, México. E-mail: n.chaveztapia@pm.me
How to cite this article: Gómez-Mendoza R, Sánchez-Hernández F, Valentin-Cortez FJ, Chávez-Tapia N. Fatty liver disease in the
pediatric population: history, definitions, and challenges in nomenclature (NAFLD/MAFLD/MASLD). Metab Target Organ
Damage. 2025;5:24. https://dx.doi.org/10.20517/mtod.2024.108
Received: 1 Nov 2024 First Decision: 19 Nov 2024 Revised: 9 Apr 2025 Accepted: 25 Apr 2025 Published: 29 Apr 2025

Academic Editors: Amedeo Lonardo, Ralf Weiskirchen Copy Editor: Ting-Ting Hu Production Editor: Ting-Ting Hu

Abstract
This review focuses on the evolution in the nomenclature of fatty liver disease in the pediatric population, from the
initial definition non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease
(MAFLD), and more recently to metabolic dysfunction-associated steatotic liver disease (MASLD). These changes
in the nomenclature aim to more accurately reflect the relation between the disease and the underlying metabolic
alterations, while also seeking to reduce the stigma associated with earlier definitions. Epidemiological data
indicate an increase in the global burden of NAFLD in the pediatric population, with a prevalence of 5%-10%, more
commonly affecting males. The condition is strongly associated with obesity, type 2 diabetes mellitus (T2DM), and
genetic factors, including the PNPLA3 polymorphism. Prevalence rates are significantly higher in Latin America
(24%-68%), which is linked to the growing epidemic of metabolic syndrome. In terms of pathophysiology,
pediatric NAFLD differs from the adult form in the histological patterns and has a strong link to insulin resistance.
Each definition of the disease has pros and cons. NAFLD is a simple definition but exclusionary, while MAFLD
incorporates metabolic factors to better characterize the disease. The most recent term, MASLD, aims to reduce
the stigma of this disease and emphasize the metabolic factor of this pathology. Various scientific societies
consistently recommend lifestyle changes as the first-line treatment, although adherence to this intervention
remains a challenge in the pediatric population. In addition, there is a strong consensus on the need for noninvasive
tools and longitudinal studies to better understand this disease in children.

Keywords: NAFLD, MAFLD, MASLD, pediatric fatty liver disease, epidemiology, metabolism

© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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