Hartmann Phillipp, Mouzaki Marialena, Hassan Sara, Kehar Mohit, Mysore Krupa R, Mauney Erin, Nonga Dieudonne, Karjoo Sara, Sood Shilpa, Tou Andrea, Brichta Christine, Herdes Rachel E, Pai Nikhil, Garner Donna K, Rinella Mary E, Noureddin Mazen, Younossi Zobair, Allen Alina, Sanyal Arun, Kohut Taisa, Kohli Rohit, Ramirez Charina M, Xanthakos Stavra, Vos Miriam B, Schwimmer Jeffrey B, Ibrahim Samar H, Panganiban Jennifer
Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.
Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego, CA, USA.
Hepatology. 2025 Jun 23. doi: 10.1097/HEP.0000000000001440.
Pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) has become more prevalent on a global scale over the last decades and is associated with significant comorbidities in childhood and a 40-fold higher risk of early mortality in young adulthood. MASLD has now become the leading indication for liver transplantation in young adults in the US. However, pediatric MASLD is still perceived as an indolent condition by many patients, families, and clinicians. In this Call to Action, we aim to raise awareness of pediatric MASLD as a public health crisis. Herein, we describe insufficient screening and disease staging practices, and lack of accurate non-invasive tests (NITs) and effective pharmacotherapy, both stemming from a paucity of multi-center clinical trials in pediatric MASLD. We provide clear steps to address this public health emergency by promoting awareness campaigns, educating and empowering patients and families, addressing barriers including access to care, nutritional and exercise support programs, establishing multidisciplinary care, launching community initiatives, and conducting clinical trials in pediatric MASLD for an age-based evaluation of novel diagnostic and therapeutic options. We conclude by highlighting the urgent need for comprehensive public health policies to control the tide of pediatric MASLD and call upon stakeholders to act now.
在过去几十年里，小儿代谢功能障碍相关脂肪性肝病（MASLD）在全球范围内变得更加普遍，并且与儿童期的显著合并症以及青年期早死风险高出40倍有关。目前，MASLD已成为美国青年成人肝移植的主要指征。然而，许多患者、家庭和临床医生仍将小儿MASLD视为一种进展缓慢的病症。在本行动呼吁中，我们旨在提高对小儿MASLD作为公共卫生危机的认识。在此，我们描述了筛查和疾病分期实践不足，以及缺乏准确的非侵入性检测（NITs）和有效的药物治疗，这两者均源于小儿MASLD多中心临床试验的匮乏。我们提供了明确的步骤来应对这一公共卫生紧急情况，包括开展提高认识运动、教育并增强患者和家庭的能力、消除包括获得医疗服务、营养和运动支持计划等障碍、建立多学科护理、发起社区倡议以及开展小儿MASLD的临床试验以对新的诊断和治疗选择进行基于年龄的评估。我们最后强调迫切需要全面的公共卫生政策来控制小儿MASLD的趋势，并呼吁利益相关者立即采取行动。
