ArticleHepatology (Baltimore, Md.)2026
Reclassifying pediatric NAFLD using the steatotic liver disease framework: A multicenter retrospective study from the NASH CRN.
Article in Hepatology (Baltimore, Md.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 2 of them syntheses that pooled it.
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Who cites it
5 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- APASL clinical practice guidelines on the management of chronic hepatitis B infection: a 2026 update.Hepatology international · 2026Guideline
- The epidemiology of metabolic dysfunction-associated steatotic liver disease among pediatric patients with type 2 diabetes: Systematic review and meta-analysis.European journal of pediatrics · 2026Pooled it
- Updates on paediatric MASLD: insights from an endocrine lens.Diabetologia · 2026Review
- Global epidemiological patterns and disease burden of metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction and alcohol-associated liver disease, and alcohol-associated liver disease.Clinical and molecular hepatology · 2026Review
- Lifespan approaches for the prevention and management of steatotic liver disease.Nature reviews. Gastroenterology & hepatology · 2026Review
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Authors and funding
15 authors.
Funding
Abstract
BACKGROUND AND
aimsThe terminology for hepatic steatosis and NAFLD was revised under the umbrella of steatotic liver disease, with metabolic dysfunction-associated steatotic liver disease (MASLD) as the primary subtype. MASLD is defined by hepatic steatosis plus at least 1 cardiometabolic risk factor. A new category, Met-ALD, describes MASLD with alcohol consumption below the defined thresholds for alcohol-associated liver disease (ALD). While adult studies have demonstrated strong concordance between NAFLD and MASLD, the applicability of this framework in children remains unclear. APPROACH AND
resultsWe assessed children clinically diagnosed with NAFLD and enrolled in the NASH CRN who had available liver histology. Clinical and demographic data, including body mass index, hepatotoxic medication use, and alcohol intake, were analyzed. Liver biopsies were centrally reviewed to confirm hepatic steatosis and evaluate for alternative etiologies. Participants were reclassified using the steatotic liver disease framework. Among 1019 children diagnosed with NAFLD, 858 (84%) met MASLD criteria. The average number of cardiometabolic risk factors per participant was 2.7±1.1; 41 (4.7%) met all five. Thirty-three participants (3.2%) were reclassified as Met-ALD, a prevalence that rose to 5.4% among adolescents. Sixty-six children (6.5%) were reclassified as drug-induced steatotic liver disease.
conclusionsMost children with NAFLD met MASLD criteria, but nearly 1 in 6 were reclassified based on alcohol use or medication exposure. These findings highlight the need for a systematic diagnostic approach accounting for metabolic risk factors, alcohol use, and medication-related liver injury.
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