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Figure 1. Key differences in MASLD between adults and children. T2D: Type 2 diabetes; MASH: metabolic dysfunction-associated
steatohepatitis; CVD: cardiovascular disease; CKD: chronic kidney disease; PCOS: polycystic ovary syndrome; MASLD: metabolic
dysfunction-associated steatotic liver disease; HCC: hepatocellular carcinoma.

Aside from the speculations regarding histological differences between zone 3 and zone 1 NASH, there may
also be histological variants specific to the pediatric population . Zone 3 NASH with pericentral lobular
[12]
inflammation and ballooned hepatocytes is similar to adult NASH, while zone 1 NASH is defined by
periportal inflammation . These differences could be useful in predicting disease progression patterns and
[12]
prognosis in children.

THE PROS AND CONS OF THE DIFFERENT DEFINITIONS OF NAFLD/MAFLD/MASLD
While historically informative, the NAFLD definition has limitations in pediatric practice and research. One
[3]
of the key strengths of the NAFLD definition is its simplicity and broad recognition . However, its
exclusive definition of the disease by the absence of significant alcohol consumption does not account for
[4]
the underlying metabolic dysfunction driving the disease .
The MAFLD definition helps bypass some of the obstacles to NAFLD by focusing on the composition of
body fat and its relationship to other metabolic risk factors . This broader definition allows for the
[6]
inclusion of individuals with moderate alcohol consumption who also have metabolic risk factors .
[5]