Metabolic dysfunction-associated steatotic liver disease-a review of the cardiometabolic perspectives and treatments in children.

The rising prevalence of childhood obesity is closely linked to the early onset of comorbid conditions, notably metabolic dysfunction-associated steatotic liver disease (MASLD), a hepatic manifestation of metabolic syndrome characterized by hepatic steatosis in the absence of significant alcohol intake. The pathophysiology of MASLD includes complex interactions among various factors such as hormonal, genetic, lifestyle and nutritional, and environmental dynamics. Emerging evidence indicates that MASLD is independently associated with a higher risk of cardiovascular disease (CVD), irrespective of traditional CV-risk factors such as hypertension, dyslipidemia, and diabetes mellitus. A comprehensive, multipronged approach is central to the detection, monitoring, and management of MASLD and associated adverse cardiovascular outcomes in children. Currently, there are no approved medications or other specific therapies for pediatric MASLD. While early stages of the disease are potentially reversible through lifestyle modifications, including diet/nutrition and physical activity, these strategies are often difficult to implement and sustain over time. Early detection of progression of MASLD to more severe conditions is hampered by the lack of reliable noninvasive methods of risk assessment tools. The objective of this review is to (1) succinctly summarize the relationship between MASLD and CVD risk in children and (2) discuss advances in MASLD management and treatment in children. We believe that this article will stimulate new avenues for research into MASLD and its broader cardiometabolic implications in pediatric populations.