Page 108 - Read Online

Gómez-Mendoza et al. Metab Target Organ Damage. 2025;5:24 https://dx.doi.org/10.20517/mtod.2024.108 Page 5 of 8

However, the MAFLD definition may exclude children with fatty liver disease who do not meet the criteria
for metabolic dysfunction, potentially overlooking a subgroup of patients with distinct pathophysiological
traits.

The MASLD definition is the latest effort by its proponents to refine nomenclature and diagnostic criteria
for fatty liver disease . By focusing on metabolic dysfunction and introducing “steatotic liver disease” as an
[4]
[5]
umbrella term, MASLD should minimize stigma and increase familiarity with the disease . Whether the
MASLD definition will be ultimately accepted, and its long-term consequences on clinical practice and
research, are still uncertain.

Depending on the chosen definition, the consequences of the diagnosis, treatment, and follow-up of
pediatric patients with fatty liver disease can vary substantially. The NAFLD definition may lead to
[3]
underdiagnoses in children who do not meet the classic profile of obesity and metabolic syndrome . In
contrast, the MAFLD and MASLD definitions share a stronger focus on metabolic dysfunction, which could
[4,6]
help identify at-risk children and allow for earlier intervention . However, such definitions may also result
in overdiagnosis in some cases, especially in children with only mild steatosis and one or two metabolic risk
factors.

STATEMENTS FROM SCIENTIFIC SOCIETIES
The American Association for the Study of Liver Diseases (AASLD) has published practice guidance on the
clinical assessment and management of NAFLD . This guidance offers actionable recommendations based
[27]
on the best available evidence to inform clinical practice . The AASLD recommendations give significant
[27]
importance to noninvasive risk stratification and the use of biomarkers to exclude advanced disease or
[27]
detect a very high probability of cirrhosis .
Regarding the new definition, the AASLD agrees that MASLD better reflects metabolic physiopathology and
emphasizes its relevance in the existing guidelines, noting that the overlap in diagnosis between NAFLD and
MASLD is > 99%. They assert that this new definition avoids stigmatization, highlights metabolic
dysfunction as the root cause, and allows inclusivity with other liver diseases .
[28]

Clinical practice guidelines on the diagnosis and treatment of NAFLD in children were recently published
by the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) .
[1]
Rinaldi and Stine first describe these guidelines as they relate to screening, diagnosis, and management of
NAFLD in the pediatric population . Diet and exercise are established as first-line therapies for pediatric
[1]
[1]
NAFLD based on the current NASPGHAN guidelines .
Guidelines for the evaluation and management of NAFLD have also been published by the Asia-Pacific
Working Party on NAFLD. These guidelines address different aspects of NAFLD, including its definition,
risk factors, assessment, and treatment, with a special emphasis on the unique features of NAFLD in the
Asia-Pacific region . Furthermore, the guidelines recognize that NAFLD requires attention in both
[29]
[29]
children and adolescents, as well as in patients with chronic viral hepatitis .
Clinical practice guidelines for the management of MASLD have been simultaneously released by the
European Association for the Study of the Liver (EASL), the European Association for the Study of Diabetes
(EASD), and the European Association for the Study of Obesity (EASO) . These guidelines include updates
[8]
on the definition, prevention, screening, diagnosis, and treatment regarding MASLD . Lifestyle
[8]
modifications and optimal management of comorbidities are important aspects of the guidelines, as is the