Panganiban Jennifer, Kehar Mohit, Ibrahim Samar H, Hartmann Phillipp, Sood Shilpa, Hassan Sara, Ramirez Charina M, Kohli Rohit, Censani Marisa, Mauney Erin, Cuda Suzanne, Karjoo Sara
Children's Hospital of Philadelphia, PA, United States.
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Canada.
Obes Pillars. 2025 Feb 1;14:100164. doi: 10.1016/j.obpill.2025.100164. eCollection 2025 Jun.
This Obesity Medicine Association (OMA) Expert Joint Perspective examines steatotic liver disease (SLD), which is composed of metabolic dysfunction-associated steatotic liver disease (MASLD), and metabolic dysfunction-associated steatohepatitis (MASH) in children with obesity. The prevalence of obesity is increasing, rates have tripled since 1963 from 5 % to now 19 % of US children affected in 2018. MASLD, is the most common liver disease seen in children, can be a precursor to the development of Type 2 Diabetes (T2DM) and is the primary reason for liver transplant listing in young adults. We must be vigilant in prevention and treatment of MASLD in childhood to prevent further progression.
This joint clinical perspective is based upon scientific evidence, peer and clinical expertise. The medical literature was reviewed via PubMed search and appropriate articles were included in this review. This work was formulated from the collaboration of eight hepatologists/gastroenterologists with MASLD expertise and two physicians from the OMA.
The authors who are experts in the field, determined sentinel questions often asked by clinicians regarding MASLD in children with obesity. They created a consensus and clinical guideline for clinicians on the screening, diagnosis, and treatment of MASLD associated with obesity in children.
Obesity and the comorbidity of MASLD is increasing in children, and this is a medical problem that needs to be addressed urgently. It is well known that children with metabolic associated chronic disease often continue to have these chronic diseases as adults, which leads to reduced life expectancy, quality of life, and increasing healthcare needs and financial burden. The authors of this paper recommend healthy weight reduction not only through lifestyle modification but through obesity pharmacotherapy and bariatric surgery. Therefore, this guidance reviews available therapies to achieve healthy weight reduction and reverse MASLD to prevent progressive liver fibrosis, and metabolic disease.
肥胖医学协会（OMA）专家联合观点探讨了脂肪性肝病（SLD），其包括肥胖儿童中的代谢功能障碍相关脂肪性肝病（MASLD）和代谢功能障碍相关脂肪性肝炎（MASH）。肥胖症的患病率正在上升，自1963年以来，美国受影响儿童的肥胖率已增至原来的三倍，从5%升至2018年的19%。MASLD是儿童中最常见的肝病，可能是2型糖尿病（T2DM）发展的先兆，也是年轻人肝移植列入名单的主要原因。我们必须警惕儿童期MASLD的预防和治疗，以防止其进一步发展。
本联合临床观点基于科学证据、同行和临床专业知识。通过PubMed搜索对医学文献进行了综述，并将适当的文章纳入本综述。这项工作由八位具有MASLD专业知识的肝病学家/胃肠病学家与OMA的两位医生合作完成。
该领域的专家作者确定了临床医生关于肥胖儿童MASLD经常问到的关键问题。他们为临床医生制定了关于肥胖儿童MASLD筛查、诊断和治疗的共识及临床指南。
肥胖儿童中MASLD及其合并症正在增加，这是一个需要紧急解决的医学问题。众所周知，患有代谢相关慢性病的儿童成年后往往仍患有这些慢性病，这会导致预期寿命缩短、生活质量下降，并增加医疗需求和经济负担。本文作者建议不仅通过生活方式改变，还通过肥胖药物治疗和减肥手术来实现健康减重。因此，本指南回顾了现有的治疗方法，以实现健康减重并逆转MASLD，预防进行性肝纤维化和代谢性疾病。
