Zhang Le, El-Shabrawi Mortada, Baur Louise A, Byrne Christopher D, Targher Giovanni, Kehar Mohit, Porta Gilda, Lee Way Seah, Lefere Sander, Turan Serap, Alisi Anna, Weiss Ram, Faienza Maria Felicia, Ashraf Ambika, Sundaram Shikha S, Srivastava Anshu, De Bruyne Ruth, Kang Yunkoo, Bacopoulou Flora, Zhou Yong-Hai, Darma Andy, Lupsor-Platon Monica, Hamaguchi Masahide, Misra Anoop, Méndez-Sánchez Nahum, Ng Nicholas Beng Hui, Marcus Claude, Staiano Amanda E, Waheed Nadia, Alqahtani Saleh A, Giannini Cosimo, Ocama Ponsiano, Nguyen Mindie H, Arias-Loste Maria Teresa, Ahmed Mohamed Rabea, Sebastiani Giada, Poovorawan Yong, Al Mahtab Mamun, Pericàs Juan M, Reverbel da Silveira Themis, Hegyi Peter, Azaz Amer, Isa Hasan M, Lertudomphonwanit Chatmanee, Farrag Mona Issa, Nugud Ahmed Abd Alwahab, Du Hong-Wei, Qi Ke-Min, Mouane Nezha, Cheng Xin-Ran, Al Lawati Tawfiq, Fagundes Eleonora D T, Ghazinyan Hasmik, Hadjipanayis Adamos, Fan Jian-Gao, Gimiga Nicoleta, Kamal Naglaa M, Ștefănescu Gabriela, Hong Li, Diaconescu Smaranda, Li Ming, George Jacob, Zheng Ming-Hua
Department of Paediatrics, Affiliated Children's Hospital of Jiangnan University (Wuxi Children's Hospital), Wuxi, China.
Department of Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Med. 2024 Jul 12;5(7):797-815.e2. doi: 10.1016/j.medj.2024.03.017. Epub 2024 Apr 26.
Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in children and adolescents, particularly those with obesity. NAFLD is considered a hepatic manifestation of the metabolic syndrome due to its close associations with abdominal obesity, insulin resistance, and atherogenic dyslipidemia. Experts have proposed an alternative terminology, metabolic dysfunction-associated fatty liver disease (MAFLD), to better reflect its pathophysiology. This study aimed to develop consensus statements and recommendations for pediatric MAFLD through collaboration among international experts.
A group of 65 experts from 35 countries and six continents, including pediatricians, hepatologists, and endocrinologists, participated in a consensus development process. The process encompassed various aspects of pediatric MAFLD, including epidemiology, mechanisms, screening, and management.
In round 1, we received 65 surveys from 35 countries and analyzed these results, which informed us that 73.3% of respondents agreed with 20 draft statements while 23.8% agreed somewhat. The mean percentage of agreement or somewhat agreement increased to 80.85% and 15.75%, respectively, in round 2. The final statements covered a wide range of topics related to epidemiology, pathophysiology, and strategies for screening and managing pediatric MAFLD.
The consensus statements and recommendations developed by an international expert panel serve to optimize clinical outcomes and improve the quality of life for children and adolescents with MAFLD. These findings emphasize the need for standardized approaches in diagnosing and treating pediatric MAFLD.
This work was funded by the National Natural Science Foundation of China (82070588, 82370577), the National Key R&D Program of China (2023YFA1800801), National High Level Hospital Clinical Research Funding (2022-PUMCH-C-014), the Wuxi Taihu Talent Plan (DJTD202106), and the Medical Key Discipline Program of Wuxi Health Commission (ZDXK2021007).
非酒精性脂肪性肝病（NAFLD）在儿童和青少年中高度流行，尤其是肥胖儿童和青少年。由于NAFLD与腹型肥胖、胰岛素抵抗和动脉粥样硬化性血脂异常密切相关，它被认为是代谢综合征的肝脏表现。专家们提出了另一种术语，即代谢功能障碍相关脂肪性肝病（MAFLD），以更好地反映其病理生理学。本研究旨在通过国际专家合作制定关于儿童MAFLD的共识声明和建议。
来自35个国家和六大洲的65名专家组成的小组，包括儿科医生、肝病学家和内分泌学家，参与了共识制定过程。该过程涵盖了儿童MAFLD的各个方面，包括流行病学、发病机制、筛查和管理。
在第一轮中，我们收到了来自35个国家的65份调查问卷，并对这些结果进行了分析，结果显示73.3%的受访者同意20份声明草案，23.8%的受访者有点同意。在第二轮中，同意或有点同意的平均百分比分别增至80.85%和15.75%。最终声明涵盖了与儿童MAFLD流行病学、病理生理学以及筛查和管理策略相关的广泛主题。
国际专家小组制定的共识声明和建议有助于优化临床结局，提高MAFLD儿童和青少年的生活质量。这些研究结果强调了在诊断和治疗儿童MAFLD时采用标准化方法的必要性。
本研究由中国国家自然科学基金（82070588、82370577）、国家重点研发计划（2023YFA1800801）、国家高水平医院临床研究专项（2022-PUMCH-C-014）、无锡太湖人才计划（DJTD202106）以及无锡市卫生健康委医学重点学科项目（ZDXK2021007）资助。
